BRS ADHD Workshop

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Bureau of Rehabilitation Services ADHD Workshop

Transcript

wwwDrNowellcom

Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

DavidNowellSeminars

DavidNowell

hellipa challenge

Perspective of this workshophellip

ldquoTop ndash downrdquo dysfunction

ADHD Executive dysfunction

ldquoBottom - uprdquo dysfunction

Central auditory processing problems Sensory processing problems

Whatrsquos the kidrsquos deal

This Dense Pudding What Does Dopamine Feel Like Why You Arenrsquot Getting Exactly What Want All the Time Lend Me Your Brain

Overview

This Dense Pudding

Normal and Abnormal Sensory Processing and Attentional Functioning

Sensory Processing Disorder

S ensory In tegration

S ensory D iscrim ination

S ensory M odu lation

S ensory D etection

Sensory Integration Terminology

Sensory Processing

Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

Sensory ProcessingIntegration Disorder and DSM-V

Whatrsquos the kidrsquos deal

Whatrsquos the kidrsquos deal

Strategies

Regulatory-Sensory Processing Disorders

Treatment ldquotop downrdquo

ldquobottom uprdquo

Regulatory-Sensory Processing Disorders

Treatment ldquotop downrdquo ldquobottom uprdquo

Central Auditory Processing Disorder

bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

Central Auditory Processing Disorder

Central Auditory Processing Disorder

CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

Central Auditory Processing Disorder

- Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

Central Auditory Processing Disorder

- Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

CAPD or ADHD

Whatrsquos the kidrsquos deal

Strategies

(C)APD

Treatment ldquotop downrdquo ldquobottom uprdquo

X

Treatment for CAPD

Environmental modifications

Treatment for CAPD

Compensatory Strategies

Self-assessment

>

Attention Deficit Hyperactivity Disorder

Increase salience

Attention Deficit Hyperactivity Disorder

(85 ndash X) x 365

ldquoIrsquom gonna eat all the gum and candy I wantrdquo

Core symptoms

Inattention distractibility

Core symptoms

Hyperactivity impulsivity

hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

mental disorder

Functional impact of core symptoms

Arousal alertness Mental effort Determination of saliency Focal maintenance

Functional impact of core symptoms

Arousal alertness Mental effort Determination of saliency Focal maintenance

Functional impact of core symptoms

Arousal alertness Mental effort Determination of saliency Focal maintenance

Functional impact of core symptoms

Arousal alertness Mental effort Determination of saliency Focal maintenance

Functional impact of core symptoms

Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

Functional impact of core symptoms

Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

Functional impact of core symptoms

Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

Functional impact of core symptoms

Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

Functional impact of core symptoms

Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

Subtypes of ADHD

ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

Subtypes of ADHD

ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

Specifed

Common comorbidities with ADHD

Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

processing challenges

Common comorbidities with ADHD

Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

processing challenges

ADHD and girls

ADHD and women

ADHD and women

More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

disorganization

Executive FunctioningAn Overarching Theme

Sensory Processing Disorder Central Auditory Processing

Disorder ADHD and Executive Dysfunction

The Executive Functions

Internalizing speech Previewing

Prioritizing Tempo control Inhibition

The Executive Functions

Determining salience (whatrsquos in it for me)

Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

Appropriate expectations

Age-appropriate expectations

Preschool 1-step errands Chores with cues Basic inhibition

Age-appropriate expectations

K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

3rd ndash 5th

Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

Age-appropriate expectations

6th ndash 8th

complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

Age-appropriate expectations

Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

already made Take othersrsquo perspective

Age-appropriate expectations

ldquowhat isrdquo vs ldquowhat could berdquo

ldquowhat isrdquo vs ldquowhat could berdquo

Inter-connectedness of systems Cortico-striatal system for example

Strategies

Pharmacotherapy

X

Behavioral Supports

A B C

A B C

behavior

A B C

consequences

A B C

antecedent

A B C

A B C

antecedent

A B C

antecedent

easy hard

A B C

consequences

R P

+

-

R+ P+

R- P-

Time Out

Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

Token economy

Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

Intrinsic motivation

A B C

consequencesX

A B C

behavior

Metacognition

Metacognitive knowledge Metacognitive strategies

ldquoLend Me Your Brainrdquo

What Does Dopamine Feel Like

The Physiology of Motivation and Reward

Preferred States What Does Dopamine Feel Like

1 Great experience2 Kodak moment3 The feeeeling

David D Nowell PhD189 May Street

Worcester Mass 01602DrNowellcom

PREFERRED STATES INVENTORY

wwwLulucom

Identify 20 peak experiences For each peak experience identify the

highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

of that moment Name it Check the 20 peak moment-feelings for

clusters groupings There will probably be 4 or 5

PREFERRED STATES INVENTORY

Find a word a label for each of the groupings

Check for accuracy (ldquogutrdquo check) Those are your preferred states your

ldquovaluesrdquo ways that you really like to feel

Now you know your motivationhellipuse this knowledge to review your daily activities and planning

PREFERRED STATES INVENTORY

PREFERRED STATES INVENTORY

Broaden and Build

ldquoNeuroMalleabilityrdquo

Why You Arenrsquot Getting Exactly What You Want All the Time

The Brainrsquos Reward and Planning System - And How It Breaks Down

The reward-and-planning system

Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

ldquowhat isrdquo vs ldquowhat could berdquo

ldquowhat isrdquo vs ldquowhat could berdquo

The reward-and-planning system

Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

Ways the reward-and-planning system can go wrong

Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

Ways the reward-and-planning system can go wrong

Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

Ways the reward-and-planning system can go wrong

Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

Ways the reward-and-planning system can go wrong

Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

Lend Me Your Brain

Supporting Clients with Executive Dysfunction

Ways the reward-and-planning system can go wrong

Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

Ways the reward-and-planning system can go wrong

Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

Ways the reward-and-planning system can go wrong

Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

Ways the reward-and-planning system can go wrong

Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

Too busy with current activity

Field dependent

Ways the reward-and-planning system can go wrong

Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

Ways the reward-and-planning system can go wrong

Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

Ways the reward-and-planning system can go wrong

Sequence problem-solve

Ways the reward-and-planning system can go wrong

Sequence problem-solve Verbal working memory Nonverbal working memory

Ways the reward-and-planning system can go wrong

Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

Ways the reward-and-planning system can go wrong

Block out distractions

The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

- E Goldberg

Ways the reward-and-planning system can go wrong

Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

Ways the reward-and-planning system can go wrong

Get the reward

Ways the reward-and-planning system can go wrong

Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

Instant gratification vs

executive gratification

A B C

behaviorx

Self-Talk Proficiency

Self-Talk Proficiency

bull -ldquoHow are you going to know when to be readyrdquo

bull -ldquoHow are you going to stop yourself fromhelliprdquo

bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

takerdquordquo

Self-Talk Proficiency

bull -ldquoHow are you going to know what you needrdquo

bull -ldquoHow are you going to know what is most importantrdquo

bull -ldquoHow are you going to decide what to do firstrdquo

bull -ldquoHow will you know when you are donerdquo

Self-Talk Proficiency

bull -ldquoHow will you continue when you are tiredrdquo

bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

differentlyrdquo ldquoWho will be the first person to notice

thathelliprdquo

Match the Picture

Distraction Delay Training

Executive Estimates Training

X

Learning Time

What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

Learning Time

Learning Time

Learning Time

Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

Asking two questionshellip

Am I having fun now And is this what I set out to do

Am I having fun nowIs

this

what

I se

t out

to

do

bullYesbullYes

bullNobullYes

bullYesbullNo

bullNobullNo

Am I having fun nowIs

this

what

I se

t out

to

do

bullFunbullOn-task

bullNot funbullOn-task

bullFunbullNot on-task

bullNot funbullNot on-task

Key Features of Video Games

Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

inappropriate behavior ndash never reverse this

Key Features of Video Games

Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

focus groups to determine what really ldquograbs lsquoemrdquo

Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

Volkow et al 2004

Increase salience

Increase salience

Quarterly QI review

The post-mortem

Your 1 Organizational Tool

Your 1 Organizational Tool

Yoga read

Staff meeting

Planningsession

Phone calls

billing

Your 1 Organizational Tool

Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

Your 1 Organizational Tool

Learn French

Stop smoking

Be a better spouse

The ldquoBig Fiverdquo

Daily focus time Valuesmotivational clarity Nutrition Movement Connection

The ldquoBig Fiverdquo

Daily focus time Valuesmotivational clarity Nutrition Movement Connection

The ldquoBig Fiverdquo

Daily focus time Valuesmotivational clarity Nutrition Movement Connection

The ldquoBig Fiverdquo

Daily focus time Valuesmotivational clarity Nutrition Movement Connection

The ldquoBig Fiverdquo

Daily focus time Valuesmotivational clarity Nutrition Movement Connection

A CHALLENGEhellip

wwwDrNowellcom

Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

DavidNowellSeminars

DavidNowell

  • Slide 1
  • hellipa challenge
  • Slide 3
  • Perspective of this workshophellip
  • ldquoTop ndash downrdquo dysfunction
  • ldquoBottom - uprdquo dysfunction
  • Slide 7
  • Whatrsquos the kidrsquos deal
  • Overview
  • This Dense Pudding
  • Sensory Processing Disorder
  • Slide 12
  • Slide 13
  • Developmental considerations
  • Sensory ProcessingIntegration Disorder and DSM-V
  • Whatrsquos the kidrsquos deal (2)
  • Slide 17
  • Whatrsquos the kidrsquos deal (3)
  • Slide 19
  • Strategies
  • Regulatory-Sensory Processing Disorders
  • Slide 22
  • Slide 23
  • Regulatory-Sensory Processing Disorders (2)
  • Slide 25
  • Central Auditory Processing Disorder
  • Slide 27
  • Slide 28
  • Slide 29
  • Central Auditory Processing Disorder (2)
  • Central Auditory Processing Disorder (3)
  • Central Auditory Processing Disorder (4)
  • CAPD or ADHD
  • Whatrsquos the kidrsquos deal (4)
  • Slide 35
  • Strategies (2)
  • (C)APD
  • Treatment for CAPD
  • Treatment for CAPD (2)
  • Self-assessment
  • Attention Deficit Hyperactivity Disorder
  • Slide 42
  • Attention Deficit Hyperactivity Disorder (2)
  • (85 ndash X) x 365
  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
  • Core symptoms
  • Core symptoms (2)
  • hellipand the rest of the criteria
  • Slide 49
  • Functional impact of core symptoms
  • Functional impact of core symptoms (2)
  • Functional impact of core symptoms (3)
  • Slide 53
  • Functional impact of core symptoms (4)
  • Functional impact of core symptoms (5)
  • Functional impact of core symptoms (6)
  • Functional impact of core symptoms (7)
  • Functional impact of core symptoms (8)
  • Functional impact of core symptoms (9)
  • Subtypes of ADHD
  • Subtypes of ADHD (2)
  • Common comorbidities with ADHD
  • Slide 63
  • Common comorbidities with ADHD (2)
  • ADHD and girls
  • Slide 66
  • Slide 67
  • ADHD and women
  • Slide 69
  • ADHD and women (2)
  • Executive Functioning An Overarching Theme
  • The Executive Functions
  • The Executive Functions (2)
  • Slide 74
  • Slide 75
  • Appropriate expectations
  • Age-appropriate expectations
  • Age-appropriate expectations (2)
  • Age-appropriate expectations (3)
  • Age-appropriate expectations (4)
  • Age-appropriate expectations (5)
  • ldquowhat isrdquo vs ldquowhat could berdquo
  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
  • Slide 84
  • Slide 85
  • Strategies (3)
  • Pharmacotherapy
  • Behavioral Supports
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • Slide 97
  • Slide 98
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Time Out
  • Token economy
  • Slide 113
  • Slide 114
  • Slide 115
  • Intrinsic motivation
  • Slide 117
  • Slide 118
  • Slide 119
  • Metacognition
  • ldquoLend Me Your Brainrdquo
  • What Does Dopamine Feel Like
  • Preferred States What Does Dopamine Feel Like
  • Slide 124
  • PREFERRED STATES INVENTORY
  • PREFERRED STATES INVENTORY (2)
  • PREFERRED STATES INVENTORY (3)
  • Slide 128
  • Slide 129
  • Broaden and Build
  • ldquoNeuroMalleabilityrdquo
  • Why You Arenrsquot Getting Exactly What You Want All the Time
  • The reward-and-planning system
  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
  • The reward-and-planning system (2)
  • Ways the reward-and-planning system can go wrong
  • Ways the reward-and-planning system can go wrong (2)
  • Ways the reward-and-planning system can go wrong (3)
  • Ways the reward-and-planning system can go wrong (4)
  • Slide 141
  • Lend Me Your Brain
  • Ways the reward-and-planning system can go wrong (5)
  • Ways the reward-and-planning system can go wrong (6)
  • Ways the reward-and-planning system can go wrong (7)
  • Slide 146
  • Ways the reward-and-planning system can go wrong (8)
  • Ways the reward-and-planning system can go wrong (9)
  • Slide 149
  • Ways the reward-and-planning system can go wrong (10)
  • Ways the reward-and-planning system can go wrong (11)
  • Slide 152
  • Ways the reward-and-planning system can go wrong (12)
  • Slide 154
  • Ways the reward-and-planning system can go wrong (13)
  • Ways the reward-and-planning system can go wrong (14)
  • Slide 157
  • Slide 158
  • Slide 159
  • Ways the reward-and-planning system can go wrong (15)
  • Ways the reward-and-planning system can go wrong (16)
  • Slide 162
  • Ways the reward-and-planning system can go wrong (17)
  • Slide 164
  • Instant gratification vs executive gratification
  • Slide 166
  • Slide 167
  • Slide 168
  • Slide 169
  • Slide 170
  • Self-Talk Proficiency
  • Self-Talk Proficiency (2)
  • Self-Talk Proficiency (3)
  • Self-Talk Proficiency (4)
  • Match the Picture
  • Slide 176
  • Slide 177
  • Distraction Delay Training
  • Slide 179
  • Slide 180
  • Executive Estimates Training
  • Learning Time
  • Learning Time (2)
  • Learning Time (3)
  • Slide 185
  • Slide 186
  • Learning Time (4)
  • Asking two questionshellip
  • Slide 189
  • Slide 190
  • Key Features of Video Games
  • Key Features of Video Games (2)
  • Methylphenidate Enhances the Saliency of a Mathematical Task by
  • Slide 194
  • Slide 195
  • Slide 196
  • Slide 197
  • Slide 198
  • Slide 199
  • Slide 200
  • Slide 201
  • Quarterly QI review
  • The post-mortem
  • Slide 204
  • Slide 205
  • Slide 206
  • Slide 207
  • Slide 208
  • Slide 209
  • Slide 210
  • The ldquoBig Fiverdquo
  • Slide 212
  • Slide 213
  • The ldquoBig Fiverdquo (2)
  • Slide 215
  • Slide 216
  • Slide 217
  • The ldquoBig Fiverdquo (3)
  • The ldquoBig Fiverdquo (4)
  • The ldquoBig Fiverdquo (5)
  • A challengehellip
  • Slide 222

    hellipa challenge

    Perspective of this workshophellip

    ldquoTop ndash downrdquo dysfunction

    ADHD Executive dysfunction

    ldquoBottom - uprdquo dysfunction

    Central auditory processing problems Sensory processing problems

    Whatrsquos the kidrsquos deal

    This Dense Pudding What Does Dopamine Feel Like Why You Arenrsquot Getting Exactly What Want All the Time Lend Me Your Brain

    Overview

    This Dense Pudding

    Normal and Abnormal Sensory Processing and Attentional Functioning

    Sensory Processing Disorder

    S ensory In tegration

    S ensory D iscrim ination

    S ensory M odu lation

    S ensory D etection

    Sensory Integration Terminology

    Sensory Processing

    Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

    Sensory ProcessingIntegration Disorder and DSM-V

    Whatrsquos the kidrsquos deal

    Whatrsquos the kidrsquos deal

    Strategies

    Regulatory-Sensory Processing Disorders

    Treatment ldquotop downrdquo

    ldquobottom uprdquo

    Regulatory-Sensory Processing Disorders

    Treatment ldquotop downrdquo ldquobottom uprdquo

    Central Auditory Processing Disorder

    bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

    Central Auditory Processing Disorder

    Central Auditory Processing Disorder

    CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

    Central Auditory Processing Disorder

    - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

    Central Auditory Processing Disorder

    - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

    CAPD or ADHD

    Whatrsquos the kidrsquos deal

    Strategies

    (C)APD

    Treatment ldquotop downrdquo ldquobottom uprdquo

    X

    Treatment for CAPD

    Environmental modifications

    Treatment for CAPD

    Compensatory Strategies

    Self-assessment

    >

    Attention Deficit Hyperactivity Disorder

    Increase salience

    Attention Deficit Hyperactivity Disorder

    (85 ndash X) x 365

    ldquoIrsquom gonna eat all the gum and candy I wantrdquo

    Core symptoms

    Inattention distractibility

    Core symptoms

    Hyperactivity impulsivity

    hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

    mental disorder

    Functional impact of core symptoms

    Arousal alertness Mental effort Determination of saliency Focal maintenance

    Functional impact of core symptoms

    Arousal alertness Mental effort Determination of saliency Focal maintenance

    Functional impact of core symptoms

    Arousal alertness Mental effort Determination of saliency Focal maintenance

    Functional impact of core symptoms

    Arousal alertness Mental effort Determination of saliency Focal maintenance

    Functional impact of core symptoms

    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

    Functional impact of core symptoms

    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

    Functional impact of core symptoms

    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

    Functional impact of core symptoms

    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

    Functional impact of core symptoms

    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

    Subtypes of ADHD

    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

    Subtypes of ADHD

    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

    Specifed

    Common comorbidities with ADHD

    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

    processing challenges

    Common comorbidities with ADHD

    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

    processing challenges

    ADHD and girls

    ADHD and women

    ADHD and women

    More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

    partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

    disorganization

    Executive FunctioningAn Overarching Theme

    Sensory Processing Disorder Central Auditory Processing

    Disorder ADHD and Executive Dysfunction

    The Executive Functions

    Internalizing speech Previewing

    Prioritizing Tempo control Inhibition

    The Executive Functions

    Determining salience (whatrsquos in it for me)

    Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

    Appropriate expectations

    Age-appropriate expectations

    Preschool 1-step errands Chores with cues Basic inhibition

    Age-appropriate expectations

    K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

    3rd ndash 5th

    Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

    Age-appropriate expectations

    6th ndash 8th

    complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

    Age-appropriate expectations

    Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

    already made Take othersrsquo perspective

    Age-appropriate expectations

    ldquowhat isrdquo vs ldquowhat could berdquo

    ldquowhat isrdquo vs ldquowhat could berdquo

    Inter-connectedness of systems Cortico-striatal system for example

    Strategies

    Pharmacotherapy

    X

    Behavioral Supports

    A B C

    A B C

    behavior

    A B C

    consequences

    A B C

    antecedent

    A B C

    A B C

    antecedent

    A B C

    antecedent

    easy hard

    A B C

    consequences

    R P

    +

    -

    R+ P+

    R- P-

    Time Out

    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

    Token economy

    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

    Intrinsic motivation

    A B C

    consequencesX

    A B C

    behavior

    Metacognition

    Metacognitive knowledge Metacognitive strategies

    ldquoLend Me Your Brainrdquo

    What Does Dopamine Feel Like

    The Physiology of Motivation and Reward

    Preferred States What Does Dopamine Feel Like

    1 Great experience2 Kodak moment3 The feeeeling

    David D Nowell PhD189 May Street

    Worcester Mass 01602DrNowellcom

    PREFERRED STATES INVENTORY

    wwwLulucom

    Identify 20 peak experiences For each peak experience identify the

    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

    of that moment Name it Check the 20 peak moment-feelings for

    clusters groupings There will probably be 4 or 5

    PREFERRED STATES INVENTORY

    Find a word a label for each of the groupings

    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

    ldquovaluesrdquo ways that you really like to feel

    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

    PREFERRED STATES INVENTORY

    PREFERRED STATES INVENTORY

    Broaden and Build

    ldquoNeuroMalleabilityrdquo

    Why You Arenrsquot Getting Exactly What You Want All the Time

    The Brainrsquos Reward and Planning System - And How It Breaks Down

    The reward-and-planning system

    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

    ldquowhat isrdquo vs ldquowhat could berdquo

    ldquowhat isrdquo vs ldquowhat could berdquo

    The reward-and-planning system

    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

    Ways the reward-and-planning system can go wrong

    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

    Ways the reward-and-planning system can go wrong

    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

    Ways the reward-and-planning system can go wrong

    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

    Ways the reward-and-planning system can go wrong

    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

    Lend Me Your Brain

    Supporting Clients with Executive Dysfunction

    Ways the reward-and-planning system can go wrong

    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

    Ways the reward-and-planning system can go wrong

    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

    Ways the reward-and-planning system can go wrong

    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

    Ways the reward-and-planning system can go wrong

    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

    Too busy with current activity

    Field dependent

    Ways the reward-and-planning system can go wrong

    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

    Ways the reward-and-planning system can go wrong

    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

    Ways the reward-and-planning system can go wrong

    Sequence problem-solve

    Ways the reward-and-planning system can go wrong

    Sequence problem-solve Verbal working memory Nonverbal working memory

    Ways the reward-and-planning system can go wrong

    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

    Ways the reward-and-planning system can go wrong

    Block out distractions

    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

    - E Goldberg

    Ways the reward-and-planning system can go wrong

    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

    Ways the reward-and-planning system can go wrong

    Get the reward

    Ways the reward-and-planning system can go wrong

    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

    Instant gratification vs

    executive gratification

    A B C

    behaviorx

    Self-Talk Proficiency

    Self-Talk Proficiency

    bull -ldquoHow are you going to know when to be readyrdquo

    bull -ldquoHow are you going to stop yourself fromhelliprdquo

    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

    takerdquordquo

    Self-Talk Proficiency

    bull -ldquoHow are you going to know what you needrdquo

    bull -ldquoHow are you going to know what is most importantrdquo

    bull -ldquoHow are you going to decide what to do firstrdquo

    bull -ldquoHow will you know when you are donerdquo

    Self-Talk Proficiency

    bull -ldquoHow will you continue when you are tiredrdquo

    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

    differentlyrdquo ldquoWho will be the first person to notice

    thathelliprdquo

    Match the Picture

    Distraction Delay Training

    Executive Estimates Training

    X

    Learning Time

    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

    Learning Time

    Learning Time

    Learning Time

    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

    Asking two questionshellip

    Am I having fun now And is this what I set out to do

    Am I having fun nowIs

    this

    what

    I se

    t out

    to

    do

    bullYesbullYes

    bullNobullYes

    bullYesbullNo

    bullNobullNo

    Am I having fun nowIs

    this

    what

    I se

    t out

    to

    do

    bullFunbullOn-task

    bullNot funbullOn-task

    bullFunbullNot on-task

    bullNot funbullNot on-task

    Key Features of Video Games

    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

    inappropriate behavior ndash never reverse this

    Key Features of Video Games

    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

    focus groups to determine what really ldquograbs lsquoemrdquo

    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

    Volkow et al 2004

    Increase salience

    Increase salience

    Quarterly QI review

    The post-mortem

    Your 1 Organizational Tool

    Your 1 Organizational Tool

    Yoga read

    Staff meeting

    Planningsession

    Phone calls

    billing

    Your 1 Organizational Tool

    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

    Your 1 Organizational Tool

    Learn French

    Stop smoking

    Be a better spouse

    The ldquoBig Fiverdquo

    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

    The ldquoBig Fiverdquo

    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

    The ldquoBig Fiverdquo

    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

    The ldquoBig Fiverdquo

    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

    The ldquoBig Fiverdquo

    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

    A CHALLENGEhellip

    wwwDrNowellcom

    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

    DavidNowellSeminars

    DavidNowell

    • Slide 1
    • hellipa challenge
    • Slide 3
    • Perspective of this workshophellip
    • ldquoTop ndash downrdquo dysfunction
    • ldquoBottom - uprdquo dysfunction
    • Slide 7
    • Whatrsquos the kidrsquos deal
    • Overview
    • This Dense Pudding
    • Sensory Processing Disorder
    • Slide 12
    • Slide 13
    • Developmental considerations
    • Sensory ProcessingIntegration Disorder and DSM-V
    • Whatrsquos the kidrsquos deal (2)
    • Slide 17
    • Whatrsquos the kidrsquos deal (3)
    • Slide 19
    • Strategies
    • Regulatory-Sensory Processing Disorders
    • Slide 22
    • Slide 23
    • Regulatory-Sensory Processing Disorders (2)
    • Slide 25
    • Central Auditory Processing Disorder
    • Slide 27
    • Slide 28
    • Slide 29
    • Central Auditory Processing Disorder (2)
    • Central Auditory Processing Disorder (3)
    • Central Auditory Processing Disorder (4)
    • CAPD or ADHD
    • Whatrsquos the kidrsquos deal (4)
    • Slide 35
    • Strategies (2)
    • (C)APD
    • Treatment for CAPD
    • Treatment for CAPD (2)
    • Self-assessment
    • Attention Deficit Hyperactivity Disorder
    • Slide 42
    • Attention Deficit Hyperactivity Disorder (2)
    • (85 ndash X) x 365
    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
    • Core symptoms
    • Core symptoms (2)
    • hellipand the rest of the criteria
    • Slide 49
    • Functional impact of core symptoms
    • Functional impact of core symptoms (2)
    • Functional impact of core symptoms (3)
    • Slide 53
    • Functional impact of core symptoms (4)
    • Functional impact of core symptoms (5)
    • Functional impact of core symptoms (6)
    • Functional impact of core symptoms (7)
    • Functional impact of core symptoms (8)
    • Functional impact of core symptoms (9)
    • Subtypes of ADHD
    • Subtypes of ADHD (2)
    • Common comorbidities with ADHD
    • Slide 63
    • Common comorbidities with ADHD (2)
    • ADHD and girls
    • Slide 66
    • Slide 67
    • ADHD and women
    • Slide 69
    • ADHD and women (2)
    • Executive Functioning An Overarching Theme
    • The Executive Functions
    • The Executive Functions (2)
    • Slide 74
    • Slide 75
    • Appropriate expectations
    • Age-appropriate expectations
    • Age-appropriate expectations (2)
    • Age-appropriate expectations (3)
    • Age-appropriate expectations (4)
    • Age-appropriate expectations (5)
    • ldquowhat isrdquo vs ldquowhat could berdquo
    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
    • Slide 84
    • Slide 85
    • Strategies (3)
    • Pharmacotherapy
    • Behavioral Supports
    • Slide 89
    • Slide 90
    • Slide 91
    • Slide 92
    • Slide 93
    • Slide 94
    • Slide 95
    • Slide 96
    • Slide 97
    • Slide 98
    • Slide 99
    • Slide 100
    • Slide 101
    • Slide 102
    • Slide 103
    • Slide 104
    • Slide 105
    • Slide 106
    • Slide 107
    • Slide 108
    • Slide 109
    • Slide 110
    • Time Out
    • Token economy
    • Slide 113
    • Slide 114
    • Slide 115
    • Intrinsic motivation
    • Slide 117
    • Slide 118
    • Slide 119
    • Metacognition
    • ldquoLend Me Your Brainrdquo
    • What Does Dopamine Feel Like
    • Preferred States What Does Dopamine Feel Like
    • Slide 124
    • PREFERRED STATES INVENTORY
    • PREFERRED STATES INVENTORY (2)
    • PREFERRED STATES INVENTORY (3)
    • Slide 128
    • Slide 129
    • Broaden and Build
    • ldquoNeuroMalleabilityrdquo
    • Why You Arenrsquot Getting Exactly What You Want All the Time
    • The reward-and-planning system
    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
    • The reward-and-planning system (2)
    • Ways the reward-and-planning system can go wrong
    • Ways the reward-and-planning system can go wrong (2)
    • Ways the reward-and-planning system can go wrong (3)
    • Ways the reward-and-planning system can go wrong (4)
    • Slide 141
    • Lend Me Your Brain
    • Ways the reward-and-planning system can go wrong (5)
    • Ways the reward-and-planning system can go wrong (6)
    • Ways the reward-and-planning system can go wrong (7)
    • Slide 146
    • Ways the reward-and-planning system can go wrong (8)
    • Ways the reward-and-planning system can go wrong (9)
    • Slide 149
    • Ways the reward-and-planning system can go wrong (10)
    • Ways the reward-and-planning system can go wrong (11)
    • Slide 152
    • Ways the reward-and-planning system can go wrong (12)
    • Slide 154
    • Ways the reward-and-planning system can go wrong (13)
    • Ways the reward-and-planning system can go wrong (14)
    • Slide 157
    • Slide 158
    • Slide 159
    • Ways the reward-and-planning system can go wrong (15)
    • Ways the reward-and-planning system can go wrong (16)
    • Slide 162
    • Ways the reward-and-planning system can go wrong (17)
    • Slide 164
    • Instant gratification vs executive gratification
    • Slide 166
    • Slide 167
    • Slide 168
    • Slide 169
    • Slide 170
    • Self-Talk Proficiency
    • Self-Talk Proficiency (2)
    • Self-Talk Proficiency (3)
    • Self-Talk Proficiency (4)
    • Match the Picture
    • Slide 176
    • Slide 177
    • Distraction Delay Training
    • Slide 179
    • Slide 180
    • Executive Estimates Training
    • Learning Time
    • Learning Time (2)
    • Learning Time (3)
    • Slide 185
    • Slide 186
    • Learning Time (4)
    • Asking two questionshellip
    • Slide 189
    • Slide 190
    • Key Features of Video Games
    • Key Features of Video Games (2)
    • Methylphenidate Enhances the Saliency of a Mathematical Task by
    • Slide 194
    • Slide 195
    • Slide 196
    • Slide 197
    • Slide 198
    • Slide 199
    • Slide 200
    • Slide 201
    • Quarterly QI review
    • The post-mortem
    • Slide 204
    • Slide 205
    • Slide 206
    • Slide 207
    • Slide 208
    • Slide 209
    • Slide 210
    • The ldquoBig Fiverdquo
    • Slide 212
    • Slide 213
    • The ldquoBig Fiverdquo (2)
    • Slide 215
    • Slide 216
    • Slide 217
    • The ldquoBig Fiverdquo (3)
    • The ldquoBig Fiverdquo (4)
    • The ldquoBig Fiverdquo (5)
    • A challengehellip
    • Slide 222

      Perspective of this workshophellip

      ldquoTop ndash downrdquo dysfunction

      ADHD Executive dysfunction

      ldquoBottom - uprdquo dysfunction

      Central auditory processing problems Sensory processing problems

      Whatrsquos the kidrsquos deal

      This Dense Pudding What Does Dopamine Feel Like Why You Arenrsquot Getting Exactly What Want All the Time Lend Me Your Brain

      Overview

      This Dense Pudding

      Normal and Abnormal Sensory Processing and Attentional Functioning

      Sensory Processing Disorder

      S ensory In tegration

      S ensory D iscrim ination

      S ensory M odu lation

      S ensory D etection

      Sensory Integration Terminology

      Sensory Processing

      Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

      Sensory ProcessingIntegration Disorder and DSM-V

      Whatrsquos the kidrsquos deal

      Whatrsquos the kidrsquos deal

      Strategies

      Regulatory-Sensory Processing Disorders

      Treatment ldquotop downrdquo

      ldquobottom uprdquo

      Regulatory-Sensory Processing Disorders

      Treatment ldquotop downrdquo ldquobottom uprdquo

      Central Auditory Processing Disorder

      bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

      Central Auditory Processing Disorder

      Central Auditory Processing Disorder

      CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

      Central Auditory Processing Disorder

      - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

      Central Auditory Processing Disorder

      - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

      CAPD or ADHD

      Whatrsquos the kidrsquos deal

      Strategies

      (C)APD

      Treatment ldquotop downrdquo ldquobottom uprdquo

      X

      Treatment for CAPD

      Environmental modifications

      Treatment for CAPD

      Compensatory Strategies

      Self-assessment

      >

      Attention Deficit Hyperactivity Disorder

      Increase salience

      Attention Deficit Hyperactivity Disorder

      (85 ndash X) x 365

      ldquoIrsquom gonna eat all the gum and candy I wantrdquo

      Core symptoms

      Inattention distractibility

      Core symptoms

      Hyperactivity impulsivity

      hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

      mental disorder

      Functional impact of core symptoms

      Arousal alertness Mental effort Determination of saliency Focal maintenance

      Functional impact of core symptoms

      Arousal alertness Mental effort Determination of saliency Focal maintenance

      Functional impact of core symptoms

      Arousal alertness Mental effort Determination of saliency Focal maintenance

      Functional impact of core symptoms

      Arousal alertness Mental effort Determination of saliency Focal maintenance

      Functional impact of core symptoms

      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

      Functional impact of core symptoms

      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

      Functional impact of core symptoms

      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

      Functional impact of core symptoms

      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

      Functional impact of core symptoms

      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

      Subtypes of ADHD

      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

      Subtypes of ADHD

      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

      Specifed

      Common comorbidities with ADHD

      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

      processing challenges

      Common comorbidities with ADHD

      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

      processing challenges

      ADHD and girls

      ADHD and women

      ADHD and women

      More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

      partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

      disorganization

      Executive FunctioningAn Overarching Theme

      Sensory Processing Disorder Central Auditory Processing

      Disorder ADHD and Executive Dysfunction

      The Executive Functions

      Internalizing speech Previewing

      Prioritizing Tempo control Inhibition

      The Executive Functions

      Determining salience (whatrsquos in it for me)

      Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

      Appropriate expectations

      Age-appropriate expectations

      Preschool 1-step errands Chores with cues Basic inhibition

      Age-appropriate expectations

      K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

      3rd ndash 5th

      Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

      Age-appropriate expectations

      6th ndash 8th

      complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

      Age-appropriate expectations

      Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

      already made Take othersrsquo perspective

      Age-appropriate expectations

      ldquowhat isrdquo vs ldquowhat could berdquo

      ldquowhat isrdquo vs ldquowhat could berdquo

      Inter-connectedness of systems Cortico-striatal system for example

      Strategies

      Pharmacotherapy

      X

      Behavioral Supports

      A B C

      A B C

      behavior

      A B C

      consequences

      A B C

      antecedent

      A B C

      A B C

      antecedent

      A B C

      antecedent

      easy hard

      A B C

      consequences

      R P

      +

      -

      R+ P+

      R- P-

      Time Out

      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

      Token economy

      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

      Intrinsic motivation

      A B C

      consequencesX

      A B C

      behavior

      Metacognition

      Metacognitive knowledge Metacognitive strategies

      ldquoLend Me Your Brainrdquo

      What Does Dopamine Feel Like

      The Physiology of Motivation and Reward

      Preferred States What Does Dopamine Feel Like

      1 Great experience2 Kodak moment3 The feeeeling

      David D Nowell PhD189 May Street

      Worcester Mass 01602DrNowellcom

      PREFERRED STATES INVENTORY

      wwwLulucom

      Identify 20 peak experiences For each peak experience identify the

      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

      of that moment Name it Check the 20 peak moment-feelings for

      clusters groupings There will probably be 4 or 5

      PREFERRED STATES INVENTORY

      Find a word a label for each of the groupings

      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

      ldquovaluesrdquo ways that you really like to feel

      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

      PREFERRED STATES INVENTORY

      PREFERRED STATES INVENTORY

      Broaden and Build

      ldquoNeuroMalleabilityrdquo

      Why You Arenrsquot Getting Exactly What You Want All the Time

      The Brainrsquos Reward and Planning System - And How It Breaks Down

      The reward-and-planning system

      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

      ldquowhat isrdquo vs ldquowhat could berdquo

      ldquowhat isrdquo vs ldquowhat could berdquo

      The reward-and-planning system

      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

      Ways the reward-and-planning system can go wrong

      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

      Ways the reward-and-planning system can go wrong

      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

      Ways the reward-and-planning system can go wrong

      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

      Ways the reward-and-planning system can go wrong

      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

      Lend Me Your Brain

      Supporting Clients with Executive Dysfunction

      Ways the reward-and-planning system can go wrong

      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

      Ways the reward-and-planning system can go wrong

      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

      Ways the reward-and-planning system can go wrong

      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

      Ways the reward-and-planning system can go wrong

      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

      Too busy with current activity

      Field dependent

      Ways the reward-and-planning system can go wrong

      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

      Ways the reward-and-planning system can go wrong

      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

      Ways the reward-and-planning system can go wrong

      Sequence problem-solve

      Ways the reward-and-planning system can go wrong

      Sequence problem-solve Verbal working memory Nonverbal working memory

      Ways the reward-and-planning system can go wrong

      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

      Ways the reward-and-planning system can go wrong

      Block out distractions

      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

      - E Goldberg

      Ways the reward-and-planning system can go wrong

      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

      Ways the reward-and-planning system can go wrong

      Get the reward

      Ways the reward-and-planning system can go wrong

      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

      Instant gratification vs

      executive gratification

      A B C

      behaviorx

      Self-Talk Proficiency

      Self-Talk Proficiency

      bull -ldquoHow are you going to know when to be readyrdquo

      bull -ldquoHow are you going to stop yourself fromhelliprdquo

      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

      takerdquordquo

      Self-Talk Proficiency

      bull -ldquoHow are you going to know what you needrdquo

      bull -ldquoHow are you going to know what is most importantrdquo

      bull -ldquoHow are you going to decide what to do firstrdquo

      bull -ldquoHow will you know when you are donerdquo

      Self-Talk Proficiency

      bull -ldquoHow will you continue when you are tiredrdquo

      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

      differentlyrdquo ldquoWho will be the first person to notice

      thathelliprdquo

      Match the Picture

      Distraction Delay Training

      Executive Estimates Training

      X

      Learning Time

      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

      Learning Time

      Learning Time

      Learning Time

      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

      Asking two questionshellip

      Am I having fun now And is this what I set out to do

      Am I having fun nowIs

      this

      what

      I se

      t out

      to

      do

      bullYesbullYes

      bullNobullYes

      bullYesbullNo

      bullNobullNo

      Am I having fun nowIs

      this

      what

      I se

      t out

      to

      do

      bullFunbullOn-task

      bullNot funbullOn-task

      bullFunbullNot on-task

      bullNot funbullNot on-task

      Key Features of Video Games

      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

      inappropriate behavior ndash never reverse this

      Key Features of Video Games

      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

      focus groups to determine what really ldquograbs lsquoemrdquo

      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

      Volkow et al 2004

      Increase salience

      Increase salience

      Quarterly QI review

      The post-mortem

      Your 1 Organizational Tool

      Your 1 Organizational Tool

      Yoga read

      Staff meeting

      Planningsession

      Phone calls

      billing

      Your 1 Organizational Tool

      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

      Your 1 Organizational Tool

      Learn French

      Stop smoking

      Be a better spouse

      The ldquoBig Fiverdquo

      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

      The ldquoBig Fiverdquo

      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

      The ldquoBig Fiverdquo

      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

      The ldquoBig Fiverdquo

      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

      The ldquoBig Fiverdquo

      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

      A CHALLENGEhellip

      wwwDrNowellcom

      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

      DavidNowellSeminars

      DavidNowell

      • Slide 1
      • hellipa challenge
      • Slide 3
      • Perspective of this workshophellip
      • ldquoTop ndash downrdquo dysfunction
      • ldquoBottom - uprdquo dysfunction
      • Slide 7
      • Whatrsquos the kidrsquos deal
      • Overview
      • This Dense Pudding
      • Sensory Processing Disorder
      • Slide 12
      • Slide 13
      • Developmental considerations
      • Sensory ProcessingIntegration Disorder and DSM-V
      • Whatrsquos the kidrsquos deal (2)
      • Slide 17
      • Whatrsquos the kidrsquos deal (3)
      • Slide 19
      • Strategies
      • Regulatory-Sensory Processing Disorders
      • Slide 22
      • Slide 23
      • Regulatory-Sensory Processing Disorders (2)
      • Slide 25
      • Central Auditory Processing Disorder
      • Slide 27
      • Slide 28
      • Slide 29
      • Central Auditory Processing Disorder (2)
      • Central Auditory Processing Disorder (3)
      • Central Auditory Processing Disorder (4)
      • CAPD or ADHD
      • Whatrsquos the kidrsquos deal (4)
      • Slide 35
      • Strategies (2)
      • (C)APD
      • Treatment for CAPD
      • Treatment for CAPD (2)
      • Self-assessment
      • Attention Deficit Hyperactivity Disorder
      • Slide 42
      • Attention Deficit Hyperactivity Disorder (2)
      • (85 ndash X) x 365
      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
      • Core symptoms
      • Core symptoms (2)
      • hellipand the rest of the criteria
      • Slide 49
      • Functional impact of core symptoms
      • Functional impact of core symptoms (2)
      • Functional impact of core symptoms (3)
      • Slide 53
      • Functional impact of core symptoms (4)
      • Functional impact of core symptoms (5)
      • Functional impact of core symptoms (6)
      • Functional impact of core symptoms (7)
      • Functional impact of core symptoms (8)
      • Functional impact of core symptoms (9)
      • Subtypes of ADHD
      • Subtypes of ADHD (2)
      • Common comorbidities with ADHD
      • Slide 63
      • Common comorbidities with ADHD (2)
      • ADHD and girls
      • Slide 66
      • Slide 67
      • ADHD and women
      • Slide 69
      • ADHD and women (2)
      • Executive Functioning An Overarching Theme
      • The Executive Functions
      • The Executive Functions (2)
      • Slide 74
      • Slide 75
      • Appropriate expectations
      • Age-appropriate expectations
      • Age-appropriate expectations (2)
      • Age-appropriate expectations (3)
      • Age-appropriate expectations (4)
      • Age-appropriate expectations (5)
      • ldquowhat isrdquo vs ldquowhat could berdquo
      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
      • Slide 84
      • Slide 85
      • Strategies (3)
      • Pharmacotherapy
      • Behavioral Supports
      • Slide 89
      • Slide 90
      • Slide 91
      • Slide 92
      • Slide 93
      • Slide 94
      • Slide 95
      • Slide 96
      • Slide 97
      • Slide 98
      • Slide 99
      • Slide 100
      • Slide 101
      • Slide 102
      • Slide 103
      • Slide 104
      • Slide 105
      • Slide 106
      • Slide 107
      • Slide 108
      • Slide 109
      • Slide 110
      • Time Out
      • Token economy
      • Slide 113
      • Slide 114
      • Slide 115
      • Intrinsic motivation
      • Slide 117
      • Slide 118
      • Slide 119
      • Metacognition
      • ldquoLend Me Your Brainrdquo
      • What Does Dopamine Feel Like
      • Preferred States What Does Dopamine Feel Like
      • Slide 124
      • PREFERRED STATES INVENTORY
      • PREFERRED STATES INVENTORY (2)
      • PREFERRED STATES INVENTORY (3)
      • Slide 128
      • Slide 129
      • Broaden and Build
      • ldquoNeuroMalleabilityrdquo
      • Why You Arenrsquot Getting Exactly What You Want All the Time
      • The reward-and-planning system
      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
      • The reward-and-planning system (2)
      • Ways the reward-and-planning system can go wrong
      • Ways the reward-and-planning system can go wrong (2)
      • Ways the reward-and-planning system can go wrong (3)
      • Ways the reward-and-planning system can go wrong (4)
      • Slide 141
      • Lend Me Your Brain
      • Ways the reward-and-planning system can go wrong (5)
      • Ways the reward-and-planning system can go wrong (6)
      • Ways the reward-and-planning system can go wrong (7)
      • Slide 146
      • Ways the reward-and-planning system can go wrong (8)
      • Ways the reward-and-planning system can go wrong (9)
      • Slide 149
      • Ways the reward-and-planning system can go wrong (10)
      • Ways the reward-and-planning system can go wrong (11)
      • Slide 152
      • Ways the reward-and-planning system can go wrong (12)
      • Slide 154
      • Ways the reward-and-planning system can go wrong (13)
      • Ways the reward-and-planning system can go wrong (14)
      • Slide 157
      • Slide 158
      • Slide 159
      • Ways the reward-and-planning system can go wrong (15)
      • Ways the reward-and-planning system can go wrong (16)
      • Slide 162
      • Ways the reward-and-planning system can go wrong (17)
      • Slide 164
      • Instant gratification vs executive gratification
      • Slide 166
      • Slide 167
      • Slide 168
      • Slide 169
      • Slide 170
      • Self-Talk Proficiency
      • Self-Talk Proficiency (2)
      • Self-Talk Proficiency (3)
      • Self-Talk Proficiency (4)
      • Match the Picture
      • Slide 176
      • Slide 177
      • Distraction Delay Training
      • Slide 179
      • Slide 180
      • Executive Estimates Training
      • Learning Time
      • Learning Time (2)
      • Learning Time (3)
      • Slide 185
      • Slide 186
      • Learning Time (4)
      • Asking two questionshellip
      • Slide 189
      • Slide 190
      • Key Features of Video Games
      • Key Features of Video Games (2)
      • Methylphenidate Enhances the Saliency of a Mathematical Task by
      • Slide 194
      • Slide 195
      • Slide 196
      • Slide 197
      • Slide 198
      • Slide 199
      • Slide 200
      • Slide 201
      • Quarterly QI review
      • The post-mortem
      • Slide 204
      • Slide 205
      • Slide 206
      • Slide 207
      • Slide 208
      • Slide 209
      • Slide 210
      • The ldquoBig Fiverdquo
      • Slide 212
      • Slide 213
      • The ldquoBig Fiverdquo (2)
      • Slide 215
      • Slide 216
      • Slide 217
      • The ldquoBig Fiverdquo (3)
      • The ldquoBig Fiverdquo (4)
      • The ldquoBig Fiverdquo (5)
      • A challengehellip
      • Slide 222

        ldquoTop ndash downrdquo dysfunction

        ADHD Executive dysfunction

        ldquoBottom - uprdquo dysfunction

        Central auditory processing problems Sensory processing problems

        Whatrsquos the kidrsquos deal

        This Dense Pudding What Does Dopamine Feel Like Why You Arenrsquot Getting Exactly What Want All the Time Lend Me Your Brain

        Overview

        This Dense Pudding

        Normal and Abnormal Sensory Processing and Attentional Functioning

        Sensory Processing Disorder

        S ensory In tegration

        S ensory D iscrim ination

        S ensory M odu lation

        S ensory D etection

        Sensory Integration Terminology

        Sensory Processing

        Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

        Sensory ProcessingIntegration Disorder and DSM-V

        Whatrsquos the kidrsquos deal

        Whatrsquos the kidrsquos deal

        Strategies

        Regulatory-Sensory Processing Disorders

        Treatment ldquotop downrdquo

        ldquobottom uprdquo

        Regulatory-Sensory Processing Disorders

        Treatment ldquotop downrdquo ldquobottom uprdquo

        Central Auditory Processing Disorder

        bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

        Central Auditory Processing Disorder

        Central Auditory Processing Disorder

        CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

        Central Auditory Processing Disorder

        - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

        Central Auditory Processing Disorder

        - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

        CAPD or ADHD

        Whatrsquos the kidrsquos deal

        Strategies

        (C)APD

        Treatment ldquotop downrdquo ldquobottom uprdquo

        X

        Treatment for CAPD

        Environmental modifications

        Treatment for CAPD

        Compensatory Strategies

        Self-assessment

        >

        Attention Deficit Hyperactivity Disorder

        Increase salience

        Attention Deficit Hyperactivity Disorder

        (85 ndash X) x 365

        ldquoIrsquom gonna eat all the gum and candy I wantrdquo

        Core symptoms

        Inattention distractibility

        Core symptoms

        Hyperactivity impulsivity

        hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

        mental disorder

        Functional impact of core symptoms

        Arousal alertness Mental effort Determination of saliency Focal maintenance

        Functional impact of core symptoms

        Arousal alertness Mental effort Determination of saliency Focal maintenance

        Functional impact of core symptoms

        Arousal alertness Mental effort Determination of saliency Focal maintenance

        Functional impact of core symptoms

        Arousal alertness Mental effort Determination of saliency Focal maintenance

        Functional impact of core symptoms

        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

        Functional impact of core symptoms

        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

        Functional impact of core symptoms

        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

        Functional impact of core symptoms

        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

        Functional impact of core symptoms

        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

        Subtypes of ADHD

        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

        Subtypes of ADHD

        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

        Specifed

        Common comorbidities with ADHD

        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

        processing challenges

        Common comorbidities with ADHD

        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

        processing challenges

        ADHD and girls

        ADHD and women

        ADHD and women

        More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

        partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

        disorganization

        Executive FunctioningAn Overarching Theme

        Sensory Processing Disorder Central Auditory Processing

        Disorder ADHD and Executive Dysfunction

        The Executive Functions

        Internalizing speech Previewing

        Prioritizing Tempo control Inhibition

        The Executive Functions

        Determining salience (whatrsquos in it for me)

        Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

        Appropriate expectations

        Age-appropriate expectations

        Preschool 1-step errands Chores with cues Basic inhibition

        Age-appropriate expectations

        K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

        3rd ndash 5th

        Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

        Age-appropriate expectations

        6th ndash 8th

        complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

        Age-appropriate expectations

        Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

        already made Take othersrsquo perspective

        Age-appropriate expectations

        ldquowhat isrdquo vs ldquowhat could berdquo

        ldquowhat isrdquo vs ldquowhat could berdquo

        Inter-connectedness of systems Cortico-striatal system for example

        Strategies

        Pharmacotherapy

        X

        Behavioral Supports

        A B C

        A B C

        behavior

        A B C

        consequences

        A B C

        antecedent

        A B C

        A B C

        antecedent

        A B C

        antecedent

        easy hard

        A B C

        consequences

        R P

        +

        -

        R+ P+

        R- P-

        Time Out

        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

        Token economy

        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

        Intrinsic motivation

        A B C

        consequencesX

        A B C

        behavior

        Metacognition

        Metacognitive knowledge Metacognitive strategies

        ldquoLend Me Your Brainrdquo

        What Does Dopamine Feel Like

        The Physiology of Motivation and Reward

        Preferred States What Does Dopamine Feel Like

        1 Great experience2 Kodak moment3 The feeeeling

        David D Nowell PhD189 May Street

        Worcester Mass 01602DrNowellcom

        PREFERRED STATES INVENTORY

        wwwLulucom

        Identify 20 peak experiences For each peak experience identify the

        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

        of that moment Name it Check the 20 peak moment-feelings for

        clusters groupings There will probably be 4 or 5

        PREFERRED STATES INVENTORY

        Find a word a label for each of the groupings

        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

        ldquovaluesrdquo ways that you really like to feel

        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

        PREFERRED STATES INVENTORY

        PREFERRED STATES INVENTORY

        Broaden and Build

        ldquoNeuroMalleabilityrdquo

        Why You Arenrsquot Getting Exactly What You Want All the Time

        The Brainrsquos Reward and Planning System - And How It Breaks Down

        The reward-and-planning system

        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

        ldquowhat isrdquo vs ldquowhat could berdquo

        ldquowhat isrdquo vs ldquowhat could berdquo

        The reward-and-planning system

        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

        Ways the reward-and-planning system can go wrong

        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

        Ways the reward-and-planning system can go wrong

        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

        Ways the reward-and-planning system can go wrong

        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

        Ways the reward-and-planning system can go wrong

        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

        Lend Me Your Brain

        Supporting Clients with Executive Dysfunction

        Ways the reward-and-planning system can go wrong

        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

        Ways the reward-and-planning system can go wrong

        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

        Ways the reward-and-planning system can go wrong

        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

        Ways the reward-and-planning system can go wrong

        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

        Too busy with current activity

        Field dependent

        Ways the reward-and-planning system can go wrong

        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

        Ways the reward-and-planning system can go wrong

        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

        Ways the reward-and-planning system can go wrong

        Sequence problem-solve

        Ways the reward-and-planning system can go wrong

        Sequence problem-solve Verbal working memory Nonverbal working memory

        Ways the reward-and-planning system can go wrong

        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

        Ways the reward-and-planning system can go wrong

        Block out distractions

        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

        - E Goldberg

        Ways the reward-and-planning system can go wrong

        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

        Ways the reward-and-planning system can go wrong

        Get the reward

        Ways the reward-and-planning system can go wrong

        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

        Instant gratification vs

        executive gratification

        A B C

        behaviorx

        Self-Talk Proficiency

        Self-Talk Proficiency

        bull -ldquoHow are you going to know when to be readyrdquo

        bull -ldquoHow are you going to stop yourself fromhelliprdquo

        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

        takerdquordquo

        Self-Talk Proficiency

        bull -ldquoHow are you going to know what you needrdquo

        bull -ldquoHow are you going to know what is most importantrdquo

        bull -ldquoHow are you going to decide what to do firstrdquo

        bull -ldquoHow will you know when you are donerdquo

        Self-Talk Proficiency

        bull -ldquoHow will you continue when you are tiredrdquo

        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

        differentlyrdquo ldquoWho will be the first person to notice

        thathelliprdquo

        Match the Picture

        Distraction Delay Training

        Executive Estimates Training

        X

        Learning Time

        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

        Learning Time

        Learning Time

        Learning Time

        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

        Asking two questionshellip

        Am I having fun now And is this what I set out to do

        Am I having fun nowIs

        this

        what

        I se

        t out

        to

        do

        bullYesbullYes

        bullNobullYes

        bullYesbullNo

        bullNobullNo

        Am I having fun nowIs

        this

        what

        I se

        t out

        to

        do

        bullFunbullOn-task

        bullNot funbullOn-task

        bullFunbullNot on-task

        bullNot funbullNot on-task

        Key Features of Video Games

        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

        inappropriate behavior ndash never reverse this

        Key Features of Video Games

        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

        focus groups to determine what really ldquograbs lsquoemrdquo

        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

        Volkow et al 2004

        Increase salience

        Increase salience

        Quarterly QI review

        The post-mortem

        Your 1 Organizational Tool

        Your 1 Organizational Tool

        Yoga read

        Staff meeting

        Planningsession

        Phone calls

        billing

        Your 1 Organizational Tool

        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

        Your 1 Organizational Tool

        Learn French

        Stop smoking

        Be a better spouse

        The ldquoBig Fiverdquo

        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

        The ldquoBig Fiverdquo

        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

        The ldquoBig Fiverdquo

        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

        The ldquoBig Fiverdquo

        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

        The ldquoBig Fiverdquo

        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

        A CHALLENGEhellip

        wwwDrNowellcom

        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

        DavidNowellSeminars

        DavidNowell

        • Slide 1
        • hellipa challenge
        • Slide 3
        • Perspective of this workshophellip
        • ldquoTop ndash downrdquo dysfunction
        • ldquoBottom - uprdquo dysfunction
        • Slide 7
        • Whatrsquos the kidrsquos deal
        • Overview
        • This Dense Pudding
        • Sensory Processing Disorder
        • Slide 12
        • Slide 13
        • Developmental considerations
        • Sensory ProcessingIntegration Disorder and DSM-V
        • Whatrsquos the kidrsquos deal (2)
        • Slide 17
        • Whatrsquos the kidrsquos deal (3)
        • Slide 19
        • Strategies
        • Regulatory-Sensory Processing Disorders
        • Slide 22
        • Slide 23
        • Regulatory-Sensory Processing Disorders (2)
        • Slide 25
        • Central Auditory Processing Disorder
        • Slide 27
        • Slide 28
        • Slide 29
        • Central Auditory Processing Disorder (2)
        • Central Auditory Processing Disorder (3)
        • Central Auditory Processing Disorder (4)
        • CAPD or ADHD
        • Whatrsquos the kidrsquos deal (4)
        • Slide 35
        • Strategies (2)
        • (C)APD
        • Treatment for CAPD
        • Treatment for CAPD (2)
        • Self-assessment
        • Attention Deficit Hyperactivity Disorder
        • Slide 42
        • Attention Deficit Hyperactivity Disorder (2)
        • (85 ndash X) x 365
        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
        • Core symptoms
        • Core symptoms (2)
        • hellipand the rest of the criteria
        • Slide 49
        • Functional impact of core symptoms
        • Functional impact of core symptoms (2)
        • Functional impact of core symptoms (3)
        • Slide 53
        • Functional impact of core symptoms (4)
        • Functional impact of core symptoms (5)
        • Functional impact of core symptoms (6)
        • Functional impact of core symptoms (7)
        • Functional impact of core symptoms (8)
        • Functional impact of core symptoms (9)
        • Subtypes of ADHD
        • Subtypes of ADHD (2)
        • Common comorbidities with ADHD
        • Slide 63
        • Common comorbidities with ADHD (2)
        • ADHD and girls
        • Slide 66
        • Slide 67
        • ADHD and women
        • Slide 69
        • ADHD and women (2)
        • Executive Functioning An Overarching Theme
        • The Executive Functions
        • The Executive Functions (2)
        • Slide 74
        • Slide 75
        • Appropriate expectations
        • Age-appropriate expectations
        • Age-appropriate expectations (2)
        • Age-appropriate expectations (3)
        • Age-appropriate expectations (4)
        • Age-appropriate expectations (5)
        • ldquowhat isrdquo vs ldquowhat could berdquo
        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
        • Slide 84
        • Slide 85
        • Strategies (3)
        • Pharmacotherapy
        • Behavioral Supports
        • Slide 89
        • Slide 90
        • Slide 91
        • Slide 92
        • Slide 93
        • Slide 94
        • Slide 95
        • Slide 96
        • Slide 97
        • Slide 98
        • Slide 99
        • Slide 100
        • Slide 101
        • Slide 102
        • Slide 103
        • Slide 104
        • Slide 105
        • Slide 106
        • Slide 107
        • Slide 108
        • Slide 109
        • Slide 110
        • Time Out
        • Token economy
        • Slide 113
        • Slide 114
        • Slide 115
        • Intrinsic motivation
        • Slide 117
        • Slide 118
        • Slide 119
        • Metacognition
        • ldquoLend Me Your Brainrdquo
        • What Does Dopamine Feel Like
        • Preferred States What Does Dopamine Feel Like
        • Slide 124
        • PREFERRED STATES INVENTORY
        • PREFERRED STATES INVENTORY (2)
        • PREFERRED STATES INVENTORY (3)
        • Slide 128
        • Slide 129
        • Broaden and Build
        • ldquoNeuroMalleabilityrdquo
        • Why You Arenrsquot Getting Exactly What You Want All the Time
        • The reward-and-planning system
        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
        • The reward-and-planning system (2)
        • Ways the reward-and-planning system can go wrong
        • Ways the reward-and-planning system can go wrong (2)
        • Ways the reward-and-planning system can go wrong (3)
        • Ways the reward-and-planning system can go wrong (4)
        • Slide 141
        • Lend Me Your Brain
        • Ways the reward-and-planning system can go wrong (5)
        • Ways the reward-and-planning system can go wrong (6)
        • Ways the reward-and-planning system can go wrong (7)
        • Slide 146
        • Ways the reward-and-planning system can go wrong (8)
        • Ways the reward-and-planning system can go wrong (9)
        • Slide 149
        • Ways the reward-and-planning system can go wrong (10)
        • Ways the reward-and-planning system can go wrong (11)
        • Slide 152
        • Ways the reward-and-planning system can go wrong (12)
        • Slide 154
        • Ways the reward-and-planning system can go wrong (13)
        • Ways the reward-and-planning system can go wrong (14)
        • Slide 157
        • Slide 158
        • Slide 159
        • Ways the reward-and-planning system can go wrong (15)
        • Ways the reward-and-planning system can go wrong (16)
        • Slide 162
        • Ways the reward-and-planning system can go wrong (17)
        • Slide 164
        • Instant gratification vs executive gratification
        • Slide 166
        • Slide 167
        • Slide 168
        • Slide 169
        • Slide 170
        • Self-Talk Proficiency
        • Self-Talk Proficiency (2)
        • Self-Talk Proficiency (3)
        • Self-Talk Proficiency (4)
        • Match the Picture
        • Slide 176
        • Slide 177
        • Distraction Delay Training
        • Slide 179
        • Slide 180
        • Executive Estimates Training
        • Learning Time
        • Learning Time (2)
        • Learning Time (3)
        • Slide 185
        • Slide 186
        • Learning Time (4)
        • Asking two questionshellip
        • Slide 189
        • Slide 190
        • Key Features of Video Games
        • Key Features of Video Games (2)
        • Methylphenidate Enhances the Saliency of a Mathematical Task by
        • Slide 194
        • Slide 195
        • Slide 196
        • Slide 197
        • Slide 198
        • Slide 199
        • Slide 200
        • Slide 201
        • Quarterly QI review
        • The post-mortem
        • Slide 204
        • Slide 205
        • Slide 206
        • Slide 207
        • Slide 208
        • Slide 209
        • Slide 210
        • The ldquoBig Fiverdquo
        • Slide 212
        • Slide 213
        • The ldquoBig Fiverdquo (2)
        • Slide 215
        • Slide 216
        • Slide 217
        • The ldquoBig Fiverdquo (3)
        • The ldquoBig Fiverdquo (4)
        • The ldquoBig Fiverdquo (5)
        • A challengehellip
        • Slide 222

          ldquoBottom - uprdquo dysfunction

          Central auditory processing problems Sensory processing problems

          Whatrsquos the kidrsquos deal

          This Dense Pudding What Does Dopamine Feel Like Why You Arenrsquot Getting Exactly What Want All the Time Lend Me Your Brain

          Overview

          This Dense Pudding

          Normal and Abnormal Sensory Processing and Attentional Functioning

          Sensory Processing Disorder

          S ensory In tegration

          S ensory D iscrim ination

          S ensory M odu lation

          S ensory D etection

          Sensory Integration Terminology

          Sensory Processing

          Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

          Sensory ProcessingIntegration Disorder and DSM-V

          Whatrsquos the kidrsquos deal

          Whatrsquos the kidrsquos deal

          Strategies

          Regulatory-Sensory Processing Disorders

          Treatment ldquotop downrdquo

          ldquobottom uprdquo

          Regulatory-Sensory Processing Disorders

          Treatment ldquotop downrdquo ldquobottom uprdquo

          Central Auditory Processing Disorder

          bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

          Central Auditory Processing Disorder

          Central Auditory Processing Disorder

          CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

          Central Auditory Processing Disorder

          - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

          Central Auditory Processing Disorder

          - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

          CAPD or ADHD

          Whatrsquos the kidrsquos deal

          Strategies

          (C)APD

          Treatment ldquotop downrdquo ldquobottom uprdquo

          X

          Treatment for CAPD

          Environmental modifications

          Treatment for CAPD

          Compensatory Strategies

          Self-assessment

          >

          Attention Deficit Hyperactivity Disorder

          Increase salience

          Attention Deficit Hyperactivity Disorder

          (85 ndash X) x 365

          ldquoIrsquom gonna eat all the gum and candy I wantrdquo

          Core symptoms

          Inattention distractibility

          Core symptoms

          Hyperactivity impulsivity

          hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

          mental disorder

          Functional impact of core symptoms

          Arousal alertness Mental effort Determination of saliency Focal maintenance

          Functional impact of core symptoms

          Arousal alertness Mental effort Determination of saliency Focal maintenance

          Functional impact of core symptoms

          Arousal alertness Mental effort Determination of saliency Focal maintenance

          Functional impact of core symptoms

          Arousal alertness Mental effort Determination of saliency Focal maintenance

          Functional impact of core symptoms

          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

          Functional impact of core symptoms

          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

          Functional impact of core symptoms

          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

          Functional impact of core symptoms

          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

          Functional impact of core symptoms

          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

          Subtypes of ADHD

          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

          Subtypes of ADHD

          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

          Specifed

          Common comorbidities with ADHD

          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

          processing challenges

          Common comorbidities with ADHD

          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

          processing challenges

          ADHD and girls

          ADHD and women

          ADHD and women

          More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

          partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

          disorganization

          Executive FunctioningAn Overarching Theme

          Sensory Processing Disorder Central Auditory Processing

          Disorder ADHD and Executive Dysfunction

          The Executive Functions

          Internalizing speech Previewing

          Prioritizing Tempo control Inhibition

          The Executive Functions

          Determining salience (whatrsquos in it for me)

          Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

          Appropriate expectations

          Age-appropriate expectations

          Preschool 1-step errands Chores with cues Basic inhibition

          Age-appropriate expectations

          K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

          3rd ndash 5th

          Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

          Age-appropriate expectations

          6th ndash 8th

          complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

          Age-appropriate expectations

          Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

          already made Take othersrsquo perspective

          Age-appropriate expectations

          ldquowhat isrdquo vs ldquowhat could berdquo

          ldquowhat isrdquo vs ldquowhat could berdquo

          Inter-connectedness of systems Cortico-striatal system for example

          Strategies

          Pharmacotherapy

          X

          Behavioral Supports

          A B C

          A B C

          behavior

          A B C

          consequences

          A B C

          antecedent

          A B C

          A B C

          antecedent

          A B C

          antecedent

          easy hard

          A B C

          consequences

          R P

          +

          -

          R+ P+

          R- P-

          Time Out

          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

          Token economy

          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

          Intrinsic motivation

          A B C

          consequencesX

          A B C

          behavior

          Metacognition

          Metacognitive knowledge Metacognitive strategies

          ldquoLend Me Your Brainrdquo

          What Does Dopamine Feel Like

          The Physiology of Motivation and Reward

          Preferred States What Does Dopamine Feel Like

          1 Great experience2 Kodak moment3 The feeeeling

          David D Nowell PhD189 May Street

          Worcester Mass 01602DrNowellcom

          PREFERRED STATES INVENTORY

          wwwLulucom

          Identify 20 peak experiences For each peak experience identify the

          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

          of that moment Name it Check the 20 peak moment-feelings for

          clusters groupings There will probably be 4 or 5

          PREFERRED STATES INVENTORY

          Find a word a label for each of the groupings

          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

          ldquovaluesrdquo ways that you really like to feel

          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

          PREFERRED STATES INVENTORY

          PREFERRED STATES INVENTORY

          Broaden and Build

          ldquoNeuroMalleabilityrdquo

          Why You Arenrsquot Getting Exactly What You Want All the Time

          The Brainrsquos Reward and Planning System - And How It Breaks Down

          The reward-and-planning system

          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

          ldquowhat isrdquo vs ldquowhat could berdquo

          ldquowhat isrdquo vs ldquowhat could berdquo

          The reward-and-planning system

          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

          Ways the reward-and-planning system can go wrong

          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

          Ways the reward-and-planning system can go wrong

          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

          Ways the reward-and-planning system can go wrong

          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

          Ways the reward-and-planning system can go wrong

          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

          Lend Me Your Brain

          Supporting Clients with Executive Dysfunction

          Ways the reward-and-planning system can go wrong

          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

          Ways the reward-and-planning system can go wrong

          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

          Ways the reward-and-planning system can go wrong

          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

          Ways the reward-and-planning system can go wrong

          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

          Too busy with current activity

          Field dependent

          Ways the reward-and-planning system can go wrong

          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

          Ways the reward-and-planning system can go wrong

          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

          Ways the reward-and-planning system can go wrong

          Sequence problem-solve

          Ways the reward-and-planning system can go wrong

          Sequence problem-solve Verbal working memory Nonverbal working memory

          Ways the reward-and-planning system can go wrong

          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

          Ways the reward-and-planning system can go wrong

          Block out distractions

          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

          - E Goldberg

          Ways the reward-and-planning system can go wrong

          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

          Ways the reward-and-planning system can go wrong

          Get the reward

          Ways the reward-and-planning system can go wrong

          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

          Instant gratification vs

          executive gratification

          A B C

          behaviorx

          Self-Talk Proficiency

          Self-Talk Proficiency

          bull -ldquoHow are you going to know when to be readyrdquo

          bull -ldquoHow are you going to stop yourself fromhelliprdquo

          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

          takerdquordquo

          Self-Talk Proficiency

          bull -ldquoHow are you going to know what you needrdquo

          bull -ldquoHow are you going to know what is most importantrdquo

          bull -ldquoHow are you going to decide what to do firstrdquo

          bull -ldquoHow will you know when you are donerdquo

          Self-Talk Proficiency

          bull -ldquoHow will you continue when you are tiredrdquo

          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

          differentlyrdquo ldquoWho will be the first person to notice

          thathelliprdquo

          Match the Picture

          Distraction Delay Training

          Executive Estimates Training

          X

          Learning Time

          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

          Learning Time

          Learning Time

          Learning Time

          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

          Asking two questionshellip

          Am I having fun now And is this what I set out to do

          Am I having fun nowIs

          this

          what

          I se

          t out

          to

          do

          bullYesbullYes

          bullNobullYes

          bullYesbullNo

          bullNobullNo

          Am I having fun nowIs

          this

          what

          I se

          t out

          to

          do

          bullFunbullOn-task

          bullNot funbullOn-task

          bullFunbullNot on-task

          bullNot funbullNot on-task

          Key Features of Video Games

          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

          inappropriate behavior ndash never reverse this

          Key Features of Video Games

          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

          focus groups to determine what really ldquograbs lsquoemrdquo

          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

          Volkow et al 2004

          Increase salience

          Increase salience

          Quarterly QI review

          The post-mortem

          Your 1 Organizational Tool

          Your 1 Organizational Tool

          Yoga read

          Staff meeting

          Planningsession

          Phone calls

          billing

          Your 1 Organizational Tool

          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

          Your 1 Organizational Tool

          Learn French

          Stop smoking

          Be a better spouse

          The ldquoBig Fiverdquo

          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

          The ldquoBig Fiverdquo

          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

          The ldquoBig Fiverdquo

          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

          The ldquoBig Fiverdquo

          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

          The ldquoBig Fiverdquo

          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

          A CHALLENGEhellip

          wwwDrNowellcom

          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

          DavidNowellSeminars

          DavidNowell

          • Slide 1
          • hellipa challenge
          • Slide 3
          • Perspective of this workshophellip
          • ldquoTop ndash downrdquo dysfunction
          • ldquoBottom - uprdquo dysfunction
          • Slide 7
          • Whatrsquos the kidrsquos deal
          • Overview
          • This Dense Pudding
          • Sensory Processing Disorder
          • Slide 12
          • Slide 13
          • Developmental considerations
          • Sensory ProcessingIntegration Disorder and DSM-V
          • Whatrsquos the kidrsquos deal (2)
          • Slide 17
          • Whatrsquos the kidrsquos deal (3)
          • Slide 19
          • Strategies
          • Regulatory-Sensory Processing Disorders
          • Slide 22
          • Slide 23
          • Regulatory-Sensory Processing Disorders (2)
          • Slide 25
          • Central Auditory Processing Disorder
          • Slide 27
          • Slide 28
          • Slide 29
          • Central Auditory Processing Disorder (2)
          • Central Auditory Processing Disorder (3)
          • Central Auditory Processing Disorder (4)
          • CAPD or ADHD
          • Whatrsquos the kidrsquos deal (4)
          • Slide 35
          • Strategies (2)
          • (C)APD
          • Treatment for CAPD
          • Treatment for CAPD (2)
          • Self-assessment
          • Attention Deficit Hyperactivity Disorder
          • Slide 42
          • Attention Deficit Hyperactivity Disorder (2)
          • (85 ndash X) x 365
          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
          • Core symptoms
          • Core symptoms (2)
          • hellipand the rest of the criteria
          • Slide 49
          • Functional impact of core symptoms
          • Functional impact of core symptoms (2)
          • Functional impact of core symptoms (3)
          • Slide 53
          • Functional impact of core symptoms (4)
          • Functional impact of core symptoms (5)
          • Functional impact of core symptoms (6)
          • Functional impact of core symptoms (7)
          • Functional impact of core symptoms (8)
          • Functional impact of core symptoms (9)
          • Subtypes of ADHD
          • Subtypes of ADHD (2)
          • Common comorbidities with ADHD
          • Slide 63
          • Common comorbidities with ADHD (2)
          • ADHD and girls
          • Slide 66
          • Slide 67
          • ADHD and women
          • Slide 69
          • ADHD and women (2)
          • Executive Functioning An Overarching Theme
          • The Executive Functions
          • The Executive Functions (2)
          • Slide 74
          • Slide 75
          • Appropriate expectations
          • Age-appropriate expectations
          • Age-appropriate expectations (2)
          • Age-appropriate expectations (3)
          • Age-appropriate expectations (4)
          • Age-appropriate expectations (5)
          • ldquowhat isrdquo vs ldquowhat could berdquo
          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
          • Slide 84
          • Slide 85
          • Strategies (3)
          • Pharmacotherapy
          • Behavioral Supports
          • Slide 89
          • Slide 90
          • Slide 91
          • Slide 92
          • Slide 93
          • Slide 94
          • Slide 95
          • Slide 96
          • Slide 97
          • Slide 98
          • Slide 99
          • Slide 100
          • Slide 101
          • Slide 102
          • Slide 103
          • Slide 104
          • Slide 105
          • Slide 106
          • Slide 107
          • Slide 108
          • Slide 109
          • Slide 110
          • Time Out
          • Token economy
          • Slide 113
          • Slide 114
          • Slide 115
          • Intrinsic motivation
          • Slide 117
          • Slide 118
          • Slide 119
          • Metacognition
          • ldquoLend Me Your Brainrdquo
          • What Does Dopamine Feel Like
          • Preferred States What Does Dopamine Feel Like
          • Slide 124
          • PREFERRED STATES INVENTORY
          • PREFERRED STATES INVENTORY (2)
          • PREFERRED STATES INVENTORY (3)
          • Slide 128
          • Slide 129
          • Broaden and Build
          • ldquoNeuroMalleabilityrdquo
          • Why You Arenrsquot Getting Exactly What You Want All the Time
          • The reward-and-planning system
          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
          • The reward-and-planning system (2)
          • Ways the reward-and-planning system can go wrong
          • Ways the reward-and-planning system can go wrong (2)
          • Ways the reward-and-planning system can go wrong (3)
          • Ways the reward-and-planning system can go wrong (4)
          • Slide 141
          • Lend Me Your Brain
          • Ways the reward-and-planning system can go wrong (5)
          • Ways the reward-and-planning system can go wrong (6)
          • Ways the reward-and-planning system can go wrong (7)
          • Slide 146
          • Ways the reward-and-planning system can go wrong (8)
          • Ways the reward-and-planning system can go wrong (9)
          • Slide 149
          • Ways the reward-and-planning system can go wrong (10)
          • Ways the reward-and-planning system can go wrong (11)
          • Slide 152
          • Ways the reward-and-planning system can go wrong (12)
          • Slide 154
          • Ways the reward-and-planning system can go wrong (13)
          • Ways the reward-and-planning system can go wrong (14)
          • Slide 157
          • Slide 158
          • Slide 159
          • Ways the reward-and-planning system can go wrong (15)
          • Ways the reward-and-planning system can go wrong (16)
          • Slide 162
          • Ways the reward-and-planning system can go wrong (17)
          • Slide 164
          • Instant gratification vs executive gratification
          • Slide 166
          • Slide 167
          • Slide 168
          • Slide 169
          • Slide 170
          • Self-Talk Proficiency
          • Self-Talk Proficiency (2)
          • Self-Talk Proficiency (3)
          • Self-Talk Proficiency (4)
          • Match the Picture
          • Slide 176
          • Slide 177
          • Distraction Delay Training
          • Slide 179
          • Slide 180
          • Executive Estimates Training
          • Learning Time
          • Learning Time (2)
          • Learning Time (3)
          • Slide 185
          • Slide 186
          • Learning Time (4)
          • Asking two questionshellip
          • Slide 189
          • Slide 190
          • Key Features of Video Games
          • Key Features of Video Games (2)
          • Methylphenidate Enhances the Saliency of a Mathematical Task by
          • Slide 194
          • Slide 195
          • Slide 196
          • Slide 197
          • Slide 198
          • Slide 199
          • Slide 200
          • Slide 201
          • Quarterly QI review
          • The post-mortem
          • Slide 204
          • Slide 205
          • Slide 206
          • Slide 207
          • Slide 208
          • Slide 209
          • Slide 210
          • The ldquoBig Fiverdquo
          • Slide 212
          • Slide 213
          • The ldquoBig Fiverdquo (2)
          • Slide 215
          • Slide 216
          • Slide 217
          • The ldquoBig Fiverdquo (3)
          • The ldquoBig Fiverdquo (4)
          • The ldquoBig Fiverdquo (5)
          • A challengehellip
          • Slide 222

            Whatrsquos the kidrsquos deal

            This Dense Pudding What Does Dopamine Feel Like Why You Arenrsquot Getting Exactly What Want All the Time Lend Me Your Brain

            Overview

            This Dense Pudding

            Normal and Abnormal Sensory Processing and Attentional Functioning

            Sensory Processing Disorder

            S ensory In tegration

            S ensory D iscrim ination

            S ensory M odu lation

            S ensory D etection

            Sensory Integration Terminology

            Sensory Processing

            Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

            Sensory ProcessingIntegration Disorder and DSM-V

            Whatrsquos the kidrsquos deal

            Whatrsquos the kidrsquos deal

            Strategies

            Regulatory-Sensory Processing Disorders

            Treatment ldquotop downrdquo

            ldquobottom uprdquo

            Regulatory-Sensory Processing Disorders

            Treatment ldquotop downrdquo ldquobottom uprdquo

            Central Auditory Processing Disorder

            bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

            Central Auditory Processing Disorder

            Central Auditory Processing Disorder

            CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

            Central Auditory Processing Disorder

            - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

            Central Auditory Processing Disorder

            - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

            CAPD or ADHD

            Whatrsquos the kidrsquos deal

            Strategies

            (C)APD

            Treatment ldquotop downrdquo ldquobottom uprdquo

            X

            Treatment for CAPD

            Environmental modifications

            Treatment for CAPD

            Compensatory Strategies

            Self-assessment

            >

            Attention Deficit Hyperactivity Disorder

            Increase salience

            Attention Deficit Hyperactivity Disorder

            (85 ndash X) x 365

            ldquoIrsquom gonna eat all the gum and candy I wantrdquo

            Core symptoms

            Inattention distractibility

            Core symptoms

            Hyperactivity impulsivity

            hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

            mental disorder

            Functional impact of core symptoms

            Arousal alertness Mental effort Determination of saliency Focal maintenance

            Functional impact of core symptoms

            Arousal alertness Mental effort Determination of saliency Focal maintenance

            Functional impact of core symptoms

            Arousal alertness Mental effort Determination of saliency Focal maintenance

            Functional impact of core symptoms

            Arousal alertness Mental effort Determination of saliency Focal maintenance

            Functional impact of core symptoms

            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

            Functional impact of core symptoms

            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

            Functional impact of core symptoms

            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

            Functional impact of core symptoms

            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

            Functional impact of core symptoms

            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

            Subtypes of ADHD

            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

            Subtypes of ADHD

            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

            Specifed

            Common comorbidities with ADHD

            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

            processing challenges

            Common comorbidities with ADHD

            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

            processing challenges

            ADHD and girls

            ADHD and women

            ADHD and women

            More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

            partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

            disorganization

            Executive FunctioningAn Overarching Theme

            Sensory Processing Disorder Central Auditory Processing

            Disorder ADHD and Executive Dysfunction

            The Executive Functions

            Internalizing speech Previewing

            Prioritizing Tempo control Inhibition

            The Executive Functions

            Determining salience (whatrsquos in it for me)

            Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

            Appropriate expectations

            Age-appropriate expectations

            Preschool 1-step errands Chores with cues Basic inhibition

            Age-appropriate expectations

            K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

            3rd ndash 5th

            Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

            Age-appropriate expectations

            6th ndash 8th

            complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

            Age-appropriate expectations

            Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

            already made Take othersrsquo perspective

            Age-appropriate expectations

            ldquowhat isrdquo vs ldquowhat could berdquo

            ldquowhat isrdquo vs ldquowhat could berdquo

            Inter-connectedness of systems Cortico-striatal system for example

            Strategies

            Pharmacotherapy

            X

            Behavioral Supports

            A B C

            A B C

            behavior

            A B C

            consequences

            A B C

            antecedent

            A B C

            A B C

            antecedent

            A B C

            antecedent

            easy hard

            A B C

            consequences

            R P

            +

            -

            R+ P+

            R- P-

            Time Out

            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

            Token economy

            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

            Intrinsic motivation

            A B C

            consequencesX

            A B C

            behavior

            Metacognition

            Metacognitive knowledge Metacognitive strategies

            ldquoLend Me Your Brainrdquo

            What Does Dopamine Feel Like

            The Physiology of Motivation and Reward

            Preferred States What Does Dopamine Feel Like

            1 Great experience2 Kodak moment3 The feeeeling

            David D Nowell PhD189 May Street

            Worcester Mass 01602DrNowellcom

            PREFERRED STATES INVENTORY

            wwwLulucom

            Identify 20 peak experiences For each peak experience identify the

            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

            of that moment Name it Check the 20 peak moment-feelings for

            clusters groupings There will probably be 4 or 5

            PREFERRED STATES INVENTORY

            Find a word a label for each of the groupings

            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

            ldquovaluesrdquo ways that you really like to feel

            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

            PREFERRED STATES INVENTORY

            PREFERRED STATES INVENTORY

            Broaden and Build

            ldquoNeuroMalleabilityrdquo

            Why You Arenrsquot Getting Exactly What You Want All the Time

            The Brainrsquos Reward and Planning System - And How It Breaks Down

            The reward-and-planning system

            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

            ldquowhat isrdquo vs ldquowhat could berdquo

            ldquowhat isrdquo vs ldquowhat could berdquo

            The reward-and-planning system

            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

            Ways the reward-and-planning system can go wrong

            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

            Ways the reward-and-planning system can go wrong

            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

            Ways the reward-and-planning system can go wrong

            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

            Ways the reward-and-planning system can go wrong

            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

            Lend Me Your Brain

            Supporting Clients with Executive Dysfunction

            Ways the reward-and-planning system can go wrong

            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

            Ways the reward-and-planning system can go wrong

            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

            Ways the reward-and-planning system can go wrong

            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

            Ways the reward-and-planning system can go wrong

            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

            Too busy with current activity

            Field dependent

            Ways the reward-and-planning system can go wrong

            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

            Ways the reward-and-planning system can go wrong

            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

            Ways the reward-and-planning system can go wrong

            Sequence problem-solve

            Ways the reward-and-planning system can go wrong

            Sequence problem-solve Verbal working memory Nonverbal working memory

            Ways the reward-and-planning system can go wrong

            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

            Ways the reward-and-planning system can go wrong

            Block out distractions

            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

            - E Goldberg

            Ways the reward-and-planning system can go wrong

            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

            Ways the reward-and-planning system can go wrong

            Get the reward

            Ways the reward-and-planning system can go wrong

            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

            Instant gratification vs

            executive gratification

            A B C

            behaviorx

            Self-Talk Proficiency

            Self-Talk Proficiency

            bull -ldquoHow are you going to know when to be readyrdquo

            bull -ldquoHow are you going to stop yourself fromhelliprdquo

            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

            takerdquordquo

            Self-Talk Proficiency

            bull -ldquoHow are you going to know what you needrdquo

            bull -ldquoHow are you going to know what is most importantrdquo

            bull -ldquoHow are you going to decide what to do firstrdquo

            bull -ldquoHow will you know when you are donerdquo

            Self-Talk Proficiency

            bull -ldquoHow will you continue when you are tiredrdquo

            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

            differentlyrdquo ldquoWho will be the first person to notice

            thathelliprdquo

            Match the Picture

            Distraction Delay Training

            Executive Estimates Training

            X

            Learning Time

            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

            Learning Time

            Learning Time

            Learning Time

            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

            Asking two questionshellip

            Am I having fun now And is this what I set out to do

            Am I having fun nowIs

            this

            what

            I se

            t out

            to

            do

            bullYesbullYes

            bullNobullYes

            bullYesbullNo

            bullNobullNo

            Am I having fun nowIs

            this

            what

            I se

            t out

            to

            do

            bullFunbullOn-task

            bullNot funbullOn-task

            bullFunbullNot on-task

            bullNot funbullNot on-task

            Key Features of Video Games

            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

            inappropriate behavior ndash never reverse this

            Key Features of Video Games

            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

            focus groups to determine what really ldquograbs lsquoemrdquo

            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

            Volkow et al 2004

            Increase salience

            Increase salience

            Quarterly QI review

            The post-mortem

            Your 1 Organizational Tool

            Your 1 Organizational Tool

            Yoga read

            Staff meeting

            Planningsession

            Phone calls

            billing

            Your 1 Organizational Tool

            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

            Your 1 Organizational Tool

            Learn French

            Stop smoking

            Be a better spouse

            The ldquoBig Fiverdquo

            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

            The ldquoBig Fiverdquo

            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

            The ldquoBig Fiverdquo

            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

            The ldquoBig Fiverdquo

            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

            The ldquoBig Fiverdquo

            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

            A CHALLENGEhellip

            wwwDrNowellcom

            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

            DavidNowellSeminars

            DavidNowell

            • Slide 1
            • hellipa challenge
            • Slide 3
            • Perspective of this workshophellip
            • ldquoTop ndash downrdquo dysfunction
            • ldquoBottom - uprdquo dysfunction
            • Slide 7
            • Whatrsquos the kidrsquos deal
            • Overview
            • This Dense Pudding
            • Sensory Processing Disorder
            • Slide 12
            • Slide 13
            • Developmental considerations
            • Sensory ProcessingIntegration Disorder and DSM-V
            • Whatrsquos the kidrsquos deal (2)
            • Slide 17
            • Whatrsquos the kidrsquos deal (3)
            • Slide 19
            • Strategies
            • Regulatory-Sensory Processing Disorders
            • Slide 22
            • Slide 23
            • Regulatory-Sensory Processing Disorders (2)
            • Slide 25
            • Central Auditory Processing Disorder
            • Slide 27
            • Slide 28
            • Slide 29
            • Central Auditory Processing Disorder (2)
            • Central Auditory Processing Disorder (3)
            • Central Auditory Processing Disorder (4)
            • CAPD or ADHD
            • Whatrsquos the kidrsquos deal (4)
            • Slide 35
            • Strategies (2)
            • (C)APD
            • Treatment for CAPD
            • Treatment for CAPD (2)
            • Self-assessment
            • Attention Deficit Hyperactivity Disorder
            • Slide 42
            • Attention Deficit Hyperactivity Disorder (2)
            • (85 ndash X) x 365
            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
            • Core symptoms
            • Core symptoms (2)
            • hellipand the rest of the criteria
            • Slide 49
            • Functional impact of core symptoms
            • Functional impact of core symptoms (2)
            • Functional impact of core symptoms (3)
            • Slide 53
            • Functional impact of core symptoms (4)
            • Functional impact of core symptoms (5)
            • Functional impact of core symptoms (6)
            • Functional impact of core symptoms (7)
            • Functional impact of core symptoms (8)
            • Functional impact of core symptoms (9)
            • Subtypes of ADHD
            • Subtypes of ADHD (2)
            • Common comorbidities with ADHD
            • Slide 63
            • Common comorbidities with ADHD (2)
            • ADHD and girls
            • Slide 66
            • Slide 67
            • ADHD and women
            • Slide 69
            • ADHD and women (2)
            • Executive Functioning An Overarching Theme
            • The Executive Functions
            • The Executive Functions (2)
            • Slide 74
            • Slide 75
            • Appropriate expectations
            • Age-appropriate expectations
            • Age-appropriate expectations (2)
            • Age-appropriate expectations (3)
            • Age-appropriate expectations (4)
            • Age-appropriate expectations (5)
            • ldquowhat isrdquo vs ldquowhat could berdquo
            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
            • Slide 84
            • Slide 85
            • Strategies (3)
            • Pharmacotherapy
            • Behavioral Supports
            • Slide 89
            • Slide 90
            • Slide 91
            • Slide 92
            • Slide 93
            • Slide 94
            • Slide 95
            • Slide 96
            • Slide 97
            • Slide 98
            • Slide 99
            • Slide 100
            • Slide 101
            • Slide 102
            • Slide 103
            • Slide 104
            • Slide 105
            • Slide 106
            • Slide 107
            • Slide 108
            • Slide 109
            • Slide 110
            • Time Out
            • Token economy
            • Slide 113
            • Slide 114
            • Slide 115
            • Intrinsic motivation
            • Slide 117
            • Slide 118
            • Slide 119
            • Metacognition
            • ldquoLend Me Your Brainrdquo
            • What Does Dopamine Feel Like
            • Preferred States What Does Dopamine Feel Like
            • Slide 124
            • PREFERRED STATES INVENTORY
            • PREFERRED STATES INVENTORY (2)
            • PREFERRED STATES INVENTORY (3)
            • Slide 128
            • Slide 129
            • Broaden and Build
            • ldquoNeuroMalleabilityrdquo
            • Why You Arenrsquot Getting Exactly What You Want All the Time
            • The reward-and-planning system
            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
            • The reward-and-planning system (2)
            • Ways the reward-and-planning system can go wrong
            • Ways the reward-and-planning system can go wrong (2)
            • Ways the reward-and-planning system can go wrong (3)
            • Ways the reward-and-planning system can go wrong (4)
            • Slide 141
            • Lend Me Your Brain
            • Ways the reward-and-planning system can go wrong (5)
            • Ways the reward-and-planning system can go wrong (6)
            • Ways the reward-and-planning system can go wrong (7)
            • Slide 146
            • Ways the reward-and-planning system can go wrong (8)
            • Ways the reward-and-planning system can go wrong (9)
            • Slide 149
            • Ways the reward-and-planning system can go wrong (10)
            • Ways the reward-and-planning system can go wrong (11)
            • Slide 152
            • Ways the reward-and-planning system can go wrong (12)
            • Slide 154
            • Ways the reward-and-planning system can go wrong (13)
            • Ways the reward-and-planning system can go wrong (14)
            • Slide 157
            • Slide 158
            • Slide 159
            • Ways the reward-and-planning system can go wrong (15)
            • Ways the reward-and-planning system can go wrong (16)
            • Slide 162
            • Ways the reward-and-planning system can go wrong (17)
            • Slide 164
            • Instant gratification vs executive gratification
            • Slide 166
            • Slide 167
            • Slide 168
            • Slide 169
            • Slide 170
            • Self-Talk Proficiency
            • Self-Talk Proficiency (2)
            • Self-Talk Proficiency (3)
            • Self-Talk Proficiency (4)
            • Match the Picture
            • Slide 176
            • Slide 177
            • Distraction Delay Training
            • Slide 179
            • Slide 180
            • Executive Estimates Training
            • Learning Time
            • Learning Time (2)
            • Learning Time (3)
            • Slide 185
            • Slide 186
            • Learning Time (4)
            • Asking two questionshellip
            • Slide 189
            • Slide 190
            • Key Features of Video Games
            • Key Features of Video Games (2)
            • Methylphenidate Enhances the Saliency of a Mathematical Task by
            • Slide 194
            • Slide 195
            • Slide 196
            • Slide 197
            • Slide 198
            • Slide 199
            • Slide 200
            • Slide 201
            • Quarterly QI review
            • The post-mortem
            • Slide 204
            • Slide 205
            • Slide 206
            • Slide 207
            • Slide 208
            • Slide 209
            • Slide 210
            • The ldquoBig Fiverdquo
            • Slide 212
            • Slide 213
            • The ldquoBig Fiverdquo (2)
            • Slide 215
            • Slide 216
            • Slide 217
            • The ldquoBig Fiverdquo (3)
            • The ldquoBig Fiverdquo (4)
            • The ldquoBig Fiverdquo (5)
            • A challengehellip
            • Slide 222

              This Dense Pudding What Does Dopamine Feel Like Why You Arenrsquot Getting Exactly What Want All the Time Lend Me Your Brain

              Overview

              This Dense Pudding

              Normal and Abnormal Sensory Processing and Attentional Functioning

              Sensory Processing Disorder

              S ensory In tegration

              S ensory D iscrim ination

              S ensory M odu lation

              S ensory D etection

              Sensory Integration Terminology

              Sensory Processing

              Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

              Sensory ProcessingIntegration Disorder and DSM-V

              Whatrsquos the kidrsquos deal

              Whatrsquos the kidrsquos deal

              Strategies

              Regulatory-Sensory Processing Disorders

              Treatment ldquotop downrdquo

              ldquobottom uprdquo

              Regulatory-Sensory Processing Disorders

              Treatment ldquotop downrdquo ldquobottom uprdquo

              Central Auditory Processing Disorder

              bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

              Central Auditory Processing Disorder

              Central Auditory Processing Disorder

              CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

              Central Auditory Processing Disorder

              - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

              Central Auditory Processing Disorder

              - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

              CAPD or ADHD

              Whatrsquos the kidrsquos deal

              Strategies

              (C)APD

              Treatment ldquotop downrdquo ldquobottom uprdquo

              X

              Treatment for CAPD

              Environmental modifications

              Treatment for CAPD

              Compensatory Strategies

              Self-assessment

              >

              Attention Deficit Hyperactivity Disorder

              Increase salience

              Attention Deficit Hyperactivity Disorder

              (85 ndash X) x 365

              ldquoIrsquom gonna eat all the gum and candy I wantrdquo

              Core symptoms

              Inattention distractibility

              Core symptoms

              Hyperactivity impulsivity

              hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

              mental disorder

              Functional impact of core symptoms

              Arousal alertness Mental effort Determination of saliency Focal maintenance

              Functional impact of core symptoms

              Arousal alertness Mental effort Determination of saliency Focal maintenance

              Functional impact of core symptoms

              Arousal alertness Mental effort Determination of saliency Focal maintenance

              Functional impact of core symptoms

              Arousal alertness Mental effort Determination of saliency Focal maintenance

              Functional impact of core symptoms

              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

              Functional impact of core symptoms

              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

              Functional impact of core symptoms

              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

              Functional impact of core symptoms

              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

              Functional impact of core symptoms

              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

              Subtypes of ADHD

              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

              Subtypes of ADHD

              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

              Specifed

              Common comorbidities with ADHD

              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

              processing challenges

              Common comorbidities with ADHD

              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

              processing challenges

              ADHD and girls

              ADHD and women

              ADHD and women

              More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

              partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

              disorganization

              Executive FunctioningAn Overarching Theme

              Sensory Processing Disorder Central Auditory Processing

              Disorder ADHD and Executive Dysfunction

              The Executive Functions

              Internalizing speech Previewing

              Prioritizing Tempo control Inhibition

              The Executive Functions

              Determining salience (whatrsquos in it for me)

              Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

              Appropriate expectations

              Age-appropriate expectations

              Preschool 1-step errands Chores with cues Basic inhibition

              Age-appropriate expectations

              K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

              3rd ndash 5th

              Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

              Age-appropriate expectations

              6th ndash 8th

              complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

              Age-appropriate expectations

              Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

              already made Take othersrsquo perspective

              Age-appropriate expectations

              ldquowhat isrdquo vs ldquowhat could berdquo

              ldquowhat isrdquo vs ldquowhat could berdquo

              Inter-connectedness of systems Cortico-striatal system for example

              Strategies

              Pharmacotherapy

              X

              Behavioral Supports

              A B C

              A B C

              behavior

              A B C

              consequences

              A B C

              antecedent

              A B C

              A B C

              antecedent

              A B C

              antecedent

              easy hard

              A B C

              consequences

              R P

              +

              -

              R+ P+

              R- P-

              Time Out

              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

              Token economy

              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

              Intrinsic motivation

              A B C

              consequencesX

              A B C

              behavior

              Metacognition

              Metacognitive knowledge Metacognitive strategies

              ldquoLend Me Your Brainrdquo

              What Does Dopamine Feel Like

              The Physiology of Motivation and Reward

              Preferred States What Does Dopamine Feel Like

              1 Great experience2 Kodak moment3 The feeeeling

              David D Nowell PhD189 May Street

              Worcester Mass 01602DrNowellcom

              PREFERRED STATES INVENTORY

              wwwLulucom

              Identify 20 peak experiences For each peak experience identify the

              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

              of that moment Name it Check the 20 peak moment-feelings for

              clusters groupings There will probably be 4 or 5

              PREFERRED STATES INVENTORY

              Find a word a label for each of the groupings

              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

              ldquovaluesrdquo ways that you really like to feel

              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

              PREFERRED STATES INVENTORY

              PREFERRED STATES INVENTORY

              Broaden and Build

              ldquoNeuroMalleabilityrdquo

              Why You Arenrsquot Getting Exactly What You Want All the Time

              The Brainrsquos Reward and Planning System - And How It Breaks Down

              The reward-and-planning system

              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

              ldquowhat isrdquo vs ldquowhat could berdquo

              ldquowhat isrdquo vs ldquowhat could berdquo

              The reward-and-planning system

              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

              Ways the reward-and-planning system can go wrong

              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

              Ways the reward-and-planning system can go wrong

              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

              Ways the reward-and-planning system can go wrong

              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

              Ways the reward-and-planning system can go wrong

              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

              Lend Me Your Brain

              Supporting Clients with Executive Dysfunction

              Ways the reward-and-planning system can go wrong

              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

              Ways the reward-and-planning system can go wrong

              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

              Ways the reward-and-planning system can go wrong

              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

              Ways the reward-and-planning system can go wrong

              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

              Too busy with current activity

              Field dependent

              Ways the reward-and-planning system can go wrong

              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

              Ways the reward-and-planning system can go wrong

              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

              Ways the reward-and-planning system can go wrong

              Sequence problem-solve

              Ways the reward-and-planning system can go wrong

              Sequence problem-solve Verbal working memory Nonverbal working memory

              Ways the reward-and-planning system can go wrong

              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

              Ways the reward-and-planning system can go wrong

              Block out distractions

              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

              - E Goldberg

              Ways the reward-and-planning system can go wrong

              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

              Ways the reward-and-planning system can go wrong

              Get the reward

              Ways the reward-and-planning system can go wrong

              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

              Instant gratification vs

              executive gratification

              A B C

              behaviorx

              Self-Talk Proficiency

              Self-Talk Proficiency

              bull -ldquoHow are you going to know when to be readyrdquo

              bull -ldquoHow are you going to stop yourself fromhelliprdquo

              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

              takerdquordquo

              Self-Talk Proficiency

              bull -ldquoHow are you going to know what you needrdquo

              bull -ldquoHow are you going to know what is most importantrdquo

              bull -ldquoHow are you going to decide what to do firstrdquo

              bull -ldquoHow will you know when you are donerdquo

              Self-Talk Proficiency

              bull -ldquoHow will you continue when you are tiredrdquo

              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

              differentlyrdquo ldquoWho will be the first person to notice

              thathelliprdquo

              Match the Picture

              Distraction Delay Training

              Executive Estimates Training

              X

              Learning Time

              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

              Learning Time

              Learning Time

              Learning Time

              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

              Asking two questionshellip

              Am I having fun now And is this what I set out to do

              Am I having fun nowIs

              this

              what

              I se

              t out

              to

              do

              bullYesbullYes

              bullNobullYes

              bullYesbullNo

              bullNobullNo

              Am I having fun nowIs

              this

              what

              I se

              t out

              to

              do

              bullFunbullOn-task

              bullNot funbullOn-task

              bullFunbullNot on-task

              bullNot funbullNot on-task

              Key Features of Video Games

              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

              inappropriate behavior ndash never reverse this

              Key Features of Video Games

              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

              focus groups to determine what really ldquograbs lsquoemrdquo

              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

              Volkow et al 2004

              Increase salience

              Increase salience

              Quarterly QI review

              The post-mortem

              Your 1 Organizational Tool

              Your 1 Organizational Tool

              Yoga read

              Staff meeting

              Planningsession

              Phone calls

              billing

              Your 1 Organizational Tool

              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

              Your 1 Organizational Tool

              Learn French

              Stop smoking

              Be a better spouse

              The ldquoBig Fiverdquo

              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

              The ldquoBig Fiverdquo

              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

              The ldquoBig Fiverdquo

              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

              The ldquoBig Fiverdquo

              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

              The ldquoBig Fiverdquo

              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

              A CHALLENGEhellip

              wwwDrNowellcom

              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

              DavidNowellSeminars

              DavidNowell

              • Slide 1
              • hellipa challenge
              • Slide 3
              • Perspective of this workshophellip
              • ldquoTop ndash downrdquo dysfunction
              • ldquoBottom - uprdquo dysfunction
              • Slide 7
              • Whatrsquos the kidrsquos deal
              • Overview
              • This Dense Pudding
              • Sensory Processing Disorder
              • Slide 12
              • Slide 13
              • Developmental considerations
              • Sensory ProcessingIntegration Disorder and DSM-V
              • Whatrsquos the kidrsquos deal (2)
              • Slide 17
              • Whatrsquos the kidrsquos deal (3)
              • Slide 19
              • Strategies
              • Regulatory-Sensory Processing Disorders
              • Slide 22
              • Slide 23
              • Regulatory-Sensory Processing Disorders (2)
              • Slide 25
              • Central Auditory Processing Disorder
              • Slide 27
              • Slide 28
              • Slide 29
              • Central Auditory Processing Disorder (2)
              • Central Auditory Processing Disorder (3)
              • Central Auditory Processing Disorder (4)
              • CAPD or ADHD
              • Whatrsquos the kidrsquos deal (4)
              • Slide 35
              • Strategies (2)
              • (C)APD
              • Treatment for CAPD
              • Treatment for CAPD (2)
              • Self-assessment
              • Attention Deficit Hyperactivity Disorder
              • Slide 42
              • Attention Deficit Hyperactivity Disorder (2)
              • (85 ndash X) x 365
              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
              • Core symptoms
              • Core symptoms (2)
              • hellipand the rest of the criteria
              • Slide 49
              • Functional impact of core symptoms
              • Functional impact of core symptoms (2)
              • Functional impact of core symptoms (3)
              • Slide 53
              • Functional impact of core symptoms (4)
              • Functional impact of core symptoms (5)
              • Functional impact of core symptoms (6)
              • Functional impact of core symptoms (7)
              • Functional impact of core symptoms (8)
              • Functional impact of core symptoms (9)
              • Subtypes of ADHD
              • Subtypes of ADHD (2)
              • Common comorbidities with ADHD
              • Slide 63
              • Common comorbidities with ADHD (2)
              • ADHD and girls
              • Slide 66
              • Slide 67
              • ADHD and women
              • Slide 69
              • ADHD and women (2)
              • Executive Functioning An Overarching Theme
              • The Executive Functions
              • The Executive Functions (2)
              • Slide 74
              • Slide 75
              • Appropriate expectations
              • Age-appropriate expectations
              • Age-appropriate expectations (2)
              • Age-appropriate expectations (3)
              • Age-appropriate expectations (4)
              • Age-appropriate expectations (5)
              • ldquowhat isrdquo vs ldquowhat could berdquo
              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
              • Slide 84
              • Slide 85
              • Strategies (3)
              • Pharmacotherapy
              • Behavioral Supports
              • Slide 89
              • Slide 90
              • Slide 91
              • Slide 92
              • Slide 93
              • Slide 94
              • Slide 95
              • Slide 96
              • Slide 97
              • Slide 98
              • Slide 99
              • Slide 100
              • Slide 101
              • Slide 102
              • Slide 103
              • Slide 104
              • Slide 105
              • Slide 106
              • Slide 107
              • Slide 108
              • Slide 109
              • Slide 110
              • Time Out
              • Token economy
              • Slide 113
              • Slide 114
              • Slide 115
              • Intrinsic motivation
              • Slide 117
              • Slide 118
              • Slide 119
              • Metacognition
              • ldquoLend Me Your Brainrdquo
              • What Does Dopamine Feel Like
              • Preferred States What Does Dopamine Feel Like
              • Slide 124
              • PREFERRED STATES INVENTORY
              • PREFERRED STATES INVENTORY (2)
              • PREFERRED STATES INVENTORY (3)
              • Slide 128
              • Slide 129
              • Broaden and Build
              • ldquoNeuroMalleabilityrdquo
              • Why You Arenrsquot Getting Exactly What You Want All the Time
              • The reward-and-planning system
              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
              • The reward-and-planning system (2)
              • Ways the reward-and-planning system can go wrong
              • Ways the reward-and-planning system can go wrong (2)
              • Ways the reward-and-planning system can go wrong (3)
              • Ways the reward-and-planning system can go wrong (4)
              • Slide 141
              • Lend Me Your Brain
              • Ways the reward-and-planning system can go wrong (5)
              • Ways the reward-and-planning system can go wrong (6)
              • Ways the reward-and-planning system can go wrong (7)
              • Slide 146
              • Ways the reward-and-planning system can go wrong (8)
              • Ways the reward-and-planning system can go wrong (9)
              • Slide 149
              • Ways the reward-and-planning system can go wrong (10)
              • Ways the reward-and-planning system can go wrong (11)
              • Slide 152
              • Ways the reward-and-planning system can go wrong (12)
              • Slide 154
              • Ways the reward-and-planning system can go wrong (13)
              • Ways the reward-and-planning system can go wrong (14)
              • Slide 157
              • Slide 158
              • Slide 159
              • Ways the reward-and-planning system can go wrong (15)
              • Ways the reward-and-planning system can go wrong (16)
              • Slide 162
              • Ways the reward-and-planning system can go wrong (17)
              • Slide 164
              • Instant gratification vs executive gratification
              • Slide 166
              • Slide 167
              • Slide 168
              • Slide 169
              • Slide 170
              • Self-Talk Proficiency
              • Self-Talk Proficiency (2)
              • Self-Talk Proficiency (3)
              • Self-Talk Proficiency (4)
              • Match the Picture
              • Slide 176
              • Slide 177
              • Distraction Delay Training
              • Slide 179
              • Slide 180
              • Executive Estimates Training
              • Learning Time
              • Learning Time (2)
              • Learning Time (3)
              • Slide 185
              • Slide 186
              • Learning Time (4)
              • Asking two questionshellip
              • Slide 189
              • Slide 190
              • Key Features of Video Games
              • Key Features of Video Games (2)
              • Methylphenidate Enhances the Saliency of a Mathematical Task by
              • Slide 194
              • Slide 195
              • Slide 196
              • Slide 197
              • Slide 198
              • Slide 199
              • Slide 200
              • Slide 201
              • Quarterly QI review
              • The post-mortem
              • Slide 204
              • Slide 205
              • Slide 206
              • Slide 207
              • Slide 208
              • Slide 209
              • Slide 210
              • The ldquoBig Fiverdquo
              • Slide 212
              • Slide 213
              • The ldquoBig Fiverdquo (2)
              • Slide 215
              • Slide 216
              • Slide 217
              • The ldquoBig Fiverdquo (3)
              • The ldquoBig Fiverdquo (4)
              • The ldquoBig Fiverdquo (5)
              • A challengehellip
              • Slide 222

                This Dense Pudding

                Normal and Abnormal Sensory Processing and Attentional Functioning

                Sensory Processing Disorder

                S ensory In tegration

                S ensory D iscrim ination

                S ensory M odu lation

                S ensory D etection

                Sensory Integration Terminology

                Sensory Processing

                Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

                Sensory ProcessingIntegration Disorder and DSM-V

                Whatrsquos the kidrsquos deal

                Whatrsquos the kidrsquos deal

                Strategies

                Regulatory-Sensory Processing Disorders

                Treatment ldquotop downrdquo

                ldquobottom uprdquo

                Regulatory-Sensory Processing Disorders

                Treatment ldquotop downrdquo ldquobottom uprdquo

                Central Auditory Processing Disorder

                bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                Central Auditory Processing Disorder

                Central Auditory Processing Disorder

                CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                Central Auditory Processing Disorder

                - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                Central Auditory Processing Disorder

                - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                CAPD or ADHD

                Whatrsquos the kidrsquos deal

                Strategies

                (C)APD

                Treatment ldquotop downrdquo ldquobottom uprdquo

                X

                Treatment for CAPD

                Environmental modifications

                Treatment for CAPD

                Compensatory Strategies

                Self-assessment

                >

                Attention Deficit Hyperactivity Disorder

                Increase salience

                Attention Deficit Hyperactivity Disorder

                (85 ndash X) x 365

                ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                Core symptoms

                Inattention distractibility

                Core symptoms

                Hyperactivity impulsivity

                hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                mental disorder

                Functional impact of core symptoms

                Arousal alertness Mental effort Determination of saliency Focal maintenance

                Functional impact of core symptoms

                Arousal alertness Mental effort Determination of saliency Focal maintenance

                Functional impact of core symptoms

                Arousal alertness Mental effort Determination of saliency Focal maintenance

                Functional impact of core symptoms

                Arousal alertness Mental effort Determination of saliency Focal maintenance

                Functional impact of core symptoms

                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                Functional impact of core symptoms

                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                Functional impact of core symptoms

                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                Functional impact of core symptoms

                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                Functional impact of core symptoms

                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                Subtypes of ADHD

                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                Subtypes of ADHD

                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                Specifed

                Common comorbidities with ADHD

                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                processing challenges

                Common comorbidities with ADHD

                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                processing challenges

                ADHD and girls

                ADHD and women

                ADHD and women

                More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                disorganization

                Executive FunctioningAn Overarching Theme

                Sensory Processing Disorder Central Auditory Processing

                Disorder ADHD and Executive Dysfunction

                The Executive Functions

                Internalizing speech Previewing

                Prioritizing Tempo control Inhibition

                The Executive Functions

                Determining salience (whatrsquos in it for me)

                Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                Appropriate expectations

                Age-appropriate expectations

                Preschool 1-step errands Chores with cues Basic inhibition

                Age-appropriate expectations

                K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                3rd ndash 5th

                Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                Age-appropriate expectations

                6th ndash 8th

                complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                Age-appropriate expectations

                Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                already made Take othersrsquo perspective

                Age-appropriate expectations

                ldquowhat isrdquo vs ldquowhat could berdquo

                ldquowhat isrdquo vs ldquowhat could berdquo

                Inter-connectedness of systems Cortico-striatal system for example

                Strategies

                Pharmacotherapy

                X

                Behavioral Supports

                A B C

                A B C

                behavior

                A B C

                consequences

                A B C

                antecedent

                A B C

                A B C

                antecedent

                A B C

                antecedent

                easy hard

                A B C

                consequences

                R P

                +

                -

                R+ P+

                R- P-

                Time Out

                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                Token economy

                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                Intrinsic motivation

                A B C

                consequencesX

                A B C

                behavior

                Metacognition

                Metacognitive knowledge Metacognitive strategies

                ldquoLend Me Your Brainrdquo

                What Does Dopamine Feel Like

                The Physiology of Motivation and Reward

                Preferred States What Does Dopamine Feel Like

                1 Great experience2 Kodak moment3 The feeeeling

                David D Nowell PhD189 May Street

                Worcester Mass 01602DrNowellcom

                PREFERRED STATES INVENTORY

                wwwLulucom

                Identify 20 peak experiences For each peak experience identify the

                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                of that moment Name it Check the 20 peak moment-feelings for

                clusters groupings There will probably be 4 or 5

                PREFERRED STATES INVENTORY

                Find a word a label for each of the groupings

                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                ldquovaluesrdquo ways that you really like to feel

                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                PREFERRED STATES INVENTORY

                PREFERRED STATES INVENTORY

                Broaden and Build

                ldquoNeuroMalleabilityrdquo

                Why You Arenrsquot Getting Exactly What You Want All the Time

                The Brainrsquos Reward and Planning System - And How It Breaks Down

                The reward-and-planning system

                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                ldquowhat isrdquo vs ldquowhat could berdquo

                ldquowhat isrdquo vs ldquowhat could berdquo

                The reward-and-planning system

                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                Ways the reward-and-planning system can go wrong

                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                Ways the reward-and-planning system can go wrong

                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                Ways the reward-and-planning system can go wrong

                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                Ways the reward-and-planning system can go wrong

                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                Lend Me Your Brain

                Supporting Clients with Executive Dysfunction

                Ways the reward-and-planning system can go wrong

                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                Ways the reward-and-planning system can go wrong

                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                Ways the reward-and-planning system can go wrong

                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                Ways the reward-and-planning system can go wrong

                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                Too busy with current activity

                Field dependent

                Ways the reward-and-planning system can go wrong

                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                Ways the reward-and-planning system can go wrong

                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                Ways the reward-and-planning system can go wrong

                Sequence problem-solve

                Ways the reward-and-planning system can go wrong

                Sequence problem-solve Verbal working memory Nonverbal working memory

                Ways the reward-and-planning system can go wrong

                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                Ways the reward-and-planning system can go wrong

                Block out distractions

                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                - E Goldberg

                Ways the reward-and-planning system can go wrong

                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                Ways the reward-and-planning system can go wrong

                Get the reward

                Ways the reward-and-planning system can go wrong

                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                Instant gratification vs

                executive gratification

                A B C

                behaviorx

                Self-Talk Proficiency

                Self-Talk Proficiency

                bull -ldquoHow are you going to know when to be readyrdquo

                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                takerdquordquo

                Self-Talk Proficiency

                bull -ldquoHow are you going to know what you needrdquo

                bull -ldquoHow are you going to know what is most importantrdquo

                bull -ldquoHow are you going to decide what to do firstrdquo

                bull -ldquoHow will you know when you are donerdquo

                Self-Talk Proficiency

                bull -ldquoHow will you continue when you are tiredrdquo

                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                differentlyrdquo ldquoWho will be the first person to notice

                thathelliprdquo

                Match the Picture

                Distraction Delay Training

                Executive Estimates Training

                X

                Learning Time

                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                Learning Time

                Learning Time

                Learning Time

                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                Asking two questionshellip

                Am I having fun now And is this what I set out to do

                Am I having fun nowIs

                this

                what

                I se

                t out

                to

                do

                bullYesbullYes

                bullNobullYes

                bullYesbullNo

                bullNobullNo

                Am I having fun nowIs

                this

                what

                I se

                t out

                to

                do

                bullFunbullOn-task

                bullNot funbullOn-task

                bullFunbullNot on-task

                bullNot funbullNot on-task

                Key Features of Video Games

                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                inappropriate behavior ndash never reverse this

                Key Features of Video Games

                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                focus groups to determine what really ldquograbs lsquoemrdquo

                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                Volkow et al 2004

                Increase salience

                Increase salience

                Quarterly QI review

                The post-mortem

                Your 1 Organizational Tool

                Your 1 Organizational Tool

                Yoga read

                Staff meeting

                Planningsession

                Phone calls

                billing

                Your 1 Organizational Tool

                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                Your 1 Organizational Tool

                Learn French

                Stop smoking

                Be a better spouse

                The ldquoBig Fiverdquo

                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                The ldquoBig Fiverdquo

                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                The ldquoBig Fiverdquo

                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                The ldquoBig Fiverdquo

                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                The ldquoBig Fiverdquo

                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                A CHALLENGEhellip

                wwwDrNowellcom

                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                DavidNowellSeminars

                DavidNowell

                • Slide 1
                • hellipa challenge
                • Slide 3
                • Perspective of this workshophellip
                • ldquoTop ndash downrdquo dysfunction
                • ldquoBottom - uprdquo dysfunction
                • Slide 7
                • Whatrsquos the kidrsquos deal
                • Overview
                • This Dense Pudding
                • Sensory Processing Disorder
                • Slide 12
                • Slide 13
                • Developmental considerations
                • Sensory ProcessingIntegration Disorder and DSM-V
                • Whatrsquos the kidrsquos deal (2)
                • Slide 17
                • Whatrsquos the kidrsquos deal (3)
                • Slide 19
                • Strategies
                • Regulatory-Sensory Processing Disorders
                • Slide 22
                • Slide 23
                • Regulatory-Sensory Processing Disorders (2)
                • Slide 25
                • Central Auditory Processing Disorder
                • Slide 27
                • Slide 28
                • Slide 29
                • Central Auditory Processing Disorder (2)
                • Central Auditory Processing Disorder (3)
                • Central Auditory Processing Disorder (4)
                • CAPD or ADHD
                • Whatrsquos the kidrsquos deal (4)
                • Slide 35
                • Strategies (2)
                • (C)APD
                • Treatment for CAPD
                • Treatment for CAPD (2)
                • Self-assessment
                • Attention Deficit Hyperactivity Disorder
                • Slide 42
                • Attention Deficit Hyperactivity Disorder (2)
                • (85 ndash X) x 365
                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                • Core symptoms
                • Core symptoms (2)
                • hellipand the rest of the criteria
                • Slide 49
                • Functional impact of core symptoms
                • Functional impact of core symptoms (2)
                • Functional impact of core symptoms (3)
                • Slide 53
                • Functional impact of core symptoms (4)
                • Functional impact of core symptoms (5)
                • Functional impact of core symptoms (6)
                • Functional impact of core symptoms (7)
                • Functional impact of core symptoms (8)
                • Functional impact of core symptoms (9)
                • Subtypes of ADHD
                • Subtypes of ADHD (2)
                • Common comorbidities with ADHD
                • Slide 63
                • Common comorbidities with ADHD (2)
                • ADHD and girls
                • Slide 66
                • Slide 67
                • ADHD and women
                • Slide 69
                • ADHD and women (2)
                • Executive Functioning An Overarching Theme
                • The Executive Functions
                • The Executive Functions (2)
                • Slide 74
                • Slide 75
                • Appropriate expectations
                • Age-appropriate expectations
                • Age-appropriate expectations (2)
                • Age-appropriate expectations (3)
                • Age-appropriate expectations (4)
                • Age-appropriate expectations (5)
                • ldquowhat isrdquo vs ldquowhat could berdquo
                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                • Slide 84
                • Slide 85
                • Strategies (3)
                • Pharmacotherapy
                • Behavioral Supports
                • Slide 89
                • Slide 90
                • Slide 91
                • Slide 92
                • Slide 93
                • Slide 94
                • Slide 95
                • Slide 96
                • Slide 97
                • Slide 98
                • Slide 99
                • Slide 100
                • Slide 101
                • Slide 102
                • Slide 103
                • Slide 104
                • Slide 105
                • Slide 106
                • Slide 107
                • Slide 108
                • Slide 109
                • Slide 110
                • Time Out
                • Token economy
                • Slide 113
                • Slide 114
                • Slide 115
                • Intrinsic motivation
                • Slide 117
                • Slide 118
                • Slide 119
                • Metacognition
                • ldquoLend Me Your Brainrdquo
                • What Does Dopamine Feel Like
                • Preferred States What Does Dopamine Feel Like
                • Slide 124
                • PREFERRED STATES INVENTORY
                • PREFERRED STATES INVENTORY (2)
                • PREFERRED STATES INVENTORY (3)
                • Slide 128
                • Slide 129
                • Broaden and Build
                • ldquoNeuroMalleabilityrdquo
                • Why You Arenrsquot Getting Exactly What You Want All the Time
                • The reward-and-planning system
                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                • The reward-and-planning system (2)
                • Ways the reward-and-planning system can go wrong
                • Ways the reward-and-planning system can go wrong (2)
                • Ways the reward-and-planning system can go wrong (3)
                • Ways the reward-and-planning system can go wrong (4)
                • Slide 141
                • Lend Me Your Brain
                • Ways the reward-and-planning system can go wrong (5)
                • Ways the reward-and-planning system can go wrong (6)
                • Ways the reward-and-planning system can go wrong (7)
                • Slide 146
                • Ways the reward-and-planning system can go wrong (8)
                • Ways the reward-and-planning system can go wrong (9)
                • Slide 149
                • Ways the reward-and-planning system can go wrong (10)
                • Ways the reward-and-planning system can go wrong (11)
                • Slide 152
                • Ways the reward-and-planning system can go wrong (12)
                • Slide 154
                • Ways the reward-and-planning system can go wrong (13)
                • Ways the reward-and-planning system can go wrong (14)
                • Slide 157
                • Slide 158
                • Slide 159
                • Ways the reward-and-planning system can go wrong (15)
                • Ways the reward-and-planning system can go wrong (16)
                • Slide 162
                • Ways the reward-and-planning system can go wrong (17)
                • Slide 164
                • Instant gratification vs executive gratification
                • Slide 166
                • Slide 167
                • Slide 168
                • Slide 169
                • Slide 170
                • Self-Talk Proficiency
                • Self-Talk Proficiency (2)
                • Self-Talk Proficiency (3)
                • Self-Talk Proficiency (4)
                • Match the Picture
                • Slide 176
                • Slide 177
                • Distraction Delay Training
                • Slide 179
                • Slide 180
                • Executive Estimates Training
                • Learning Time
                • Learning Time (2)
                • Learning Time (3)
                • Slide 185
                • Slide 186
                • Learning Time (4)
                • Asking two questionshellip
                • Slide 189
                • Slide 190
                • Key Features of Video Games
                • Key Features of Video Games (2)
                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                • Slide 194
                • Slide 195
                • Slide 196
                • Slide 197
                • Slide 198
                • Slide 199
                • Slide 200
                • Slide 201
                • Quarterly QI review
                • The post-mortem
                • Slide 204
                • Slide 205
                • Slide 206
                • Slide 207
                • Slide 208
                • Slide 209
                • Slide 210
                • The ldquoBig Fiverdquo
                • Slide 212
                • Slide 213
                • The ldquoBig Fiverdquo (2)
                • Slide 215
                • Slide 216
                • Slide 217
                • The ldquoBig Fiverdquo (3)
                • The ldquoBig Fiverdquo (4)
                • The ldquoBig Fiverdquo (5)
                • A challengehellip
                • Slide 222

                  Sensory Processing Disorder

                  S ensory In tegration

                  S ensory D iscrim ination

                  S ensory M odu lation

                  S ensory D etection

                  Sensory Integration Terminology

                  Sensory Processing

                  Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

                  Sensory ProcessingIntegration Disorder and DSM-V

                  Whatrsquos the kidrsquos deal

                  Whatrsquos the kidrsquos deal

                  Strategies

                  Regulatory-Sensory Processing Disorders

                  Treatment ldquotop downrdquo

                  ldquobottom uprdquo

                  Regulatory-Sensory Processing Disorders

                  Treatment ldquotop downrdquo ldquobottom uprdquo

                  Central Auditory Processing Disorder

                  bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                  Central Auditory Processing Disorder

                  Central Auditory Processing Disorder

                  CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                  Central Auditory Processing Disorder

                  - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                  Central Auditory Processing Disorder

                  - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                  CAPD or ADHD

                  Whatrsquos the kidrsquos deal

                  Strategies

                  (C)APD

                  Treatment ldquotop downrdquo ldquobottom uprdquo

                  X

                  Treatment for CAPD

                  Environmental modifications

                  Treatment for CAPD

                  Compensatory Strategies

                  Self-assessment

                  >

                  Attention Deficit Hyperactivity Disorder

                  Increase salience

                  Attention Deficit Hyperactivity Disorder

                  (85 ndash X) x 365

                  ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                  Core symptoms

                  Inattention distractibility

                  Core symptoms

                  Hyperactivity impulsivity

                  hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                  mental disorder

                  Functional impact of core symptoms

                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                  Functional impact of core symptoms

                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                  Functional impact of core symptoms

                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                  Functional impact of core symptoms

                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                  Functional impact of core symptoms

                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                  Functional impact of core symptoms

                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                  Functional impact of core symptoms

                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                  Functional impact of core symptoms

                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                  Functional impact of core symptoms

                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                  Subtypes of ADHD

                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                  Subtypes of ADHD

                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                  Specifed

                  Common comorbidities with ADHD

                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                  processing challenges

                  Common comorbidities with ADHD

                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                  processing challenges

                  ADHD and girls

                  ADHD and women

                  ADHD and women

                  More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                  partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                  disorganization

                  Executive FunctioningAn Overarching Theme

                  Sensory Processing Disorder Central Auditory Processing

                  Disorder ADHD and Executive Dysfunction

                  The Executive Functions

                  Internalizing speech Previewing

                  Prioritizing Tempo control Inhibition

                  The Executive Functions

                  Determining salience (whatrsquos in it for me)

                  Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                  Appropriate expectations

                  Age-appropriate expectations

                  Preschool 1-step errands Chores with cues Basic inhibition

                  Age-appropriate expectations

                  K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                  3rd ndash 5th

                  Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                  Age-appropriate expectations

                  6th ndash 8th

                  complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                  Age-appropriate expectations

                  Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                  already made Take othersrsquo perspective

                  Age-appropriate expectations

                  ldquowhat isrdquo vs ldquowhat could berdquo

                  ldquowhat isrdquo vs ldquowhat could berdquo

                  Inter-connectedness of systems Cortico-striatal system for example

                  Strategies

                  Pharmacotherapy

                  X

                  Behavioral Supports

                  A B C

                  A B C

                  behavior

                  A B C

                  consequences

                  A B C

                  antecedent

                  A B C

                  A B C

                  antecedent

                  A B C

                  antecedent

                  easy hard

                  A B C

                  consequences

                  R P

                  +

                  -

                  R+ P+

                  R- P-

                  Time Out

                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                  Token economy

                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                  Intrinsic motivation

                  A B C

                  consequencesX

                  A B C

                  behavior

                  Metacognition

                  Metacognitive knowledge Metacognitive strategies

                  ldquoLend Me Your Brainrdquo

                  What Does Dopamine Feel Like

                  The Physiology of Motivation and Reward

                  Preferred States What Does Dopamine Feel Like

                  1 Great experience2 Kodak moment3 The feeeeling

                  David D Nowell PhD189 May Street

                  Worcester Mass 01602DrNowellcom

                  PREFERRED STATES INVENTORY

                  wwwLulucom

                  Identify 20 peak experiences For each peak experience identify the

                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                  of that moment Name it Check the 20 peak moment-feelings for

                  clusters groupings There will probably be 4 or 5

                  PREFERRED STATES INVENTORY

                  Find a word a label for each of the groupings

                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                  ldquovaluesrdquo ways that you really like to feel

                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                  PREFERRED STATES INVENTORY

                  PREFERRED STATES INVENTORY

                  Broaden and Build

                  ldquoNeuroMalleabilityrdquo

                  Why You Arenrsquot Getting Exactly What You Want All the Time

                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                  The reward-and-planning system

                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                  ldquowhat isrdquo vs ldquowhat could berdquo

                  ldquowhat isrdquo vs ldquowhat could berdquo

                  The reward-and-planning system

                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                  Ways the reward-and-planning system can go wrong

                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                  Ways the reward-and-planning system can go wrong

                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                  Ways the reward-and-planning system can go wrong

                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                  Ways the reward-and-planning system can go wrong

                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                  Lend Me Your Brain

                  Supporting Clients with Executive Dysfunction

                  Ways the reward-and-planning system can go wrong

                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                  Ways the reward-and-planning system can go wrong

                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                  Ways the reward-and-planning system can go wrong

                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                  Ways the reward-and-planning system can go wrong

                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                  Too busy with current activity

                  Field dependent

                  Ways the reward-and-planning system can go wrong

                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                  Ways the reward-and-planning system can go wrong

                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                  Ways the reward-and-planning system can go wrong

                  Sequence problem-solve

                  Ways the reward-and-planning system can go wrong

                  Sequence problem-solve Verbal working memory Nonverbal working memory

                  Ways the reward-and-planning system can go wrong

                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                  Ways the reward-and-planning system can go wrong

                  Block out distractions

                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                  - E Goldberg

                  Ways the reward-and-planning system can go wrong

                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                  Ways the reward-and-planning system can go wrong

                  Get the reward

                  Ways the reward-and-planning system can go wrong

                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                  Instant gratification vs

                  executive gratification

                  A B C

                  behaviorx

                  Self-Talk Proficiency

                  Self-Talk Proficiency

                  bull -ldquoHow are you going to know when to be readyrdquo

                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                  takerdquordquo

                  Self-Talk Proficiency

                  bull -ldquoHow are you going to know what you needrdquo

                  bull -ldquoHow are you going to know what is most importantrdquo

                  bull -ldquoHow are you going to decide what to do firstrdquo

                  bull -ldquoHow will you know when you are donerdquo

                  Self-Talk Proficiency

                  bull -ldquoHow will you continue when you are tiredrdquo

                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                  differentlyrdquo ldquoWho will be the first person to notice

                  thathelliprdquo

                  Match the Picture

                  Distraction Delay Training

                  Executive Estimates Training

                  X

                  Learning Time

                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                  Learning Time

                  Learning Time

                  Learning Time

                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                  Asking two questionshellip

                  Am I having fun now And is this what I set out to do

                  Am I having fun nowIs

                  this

                  what

                  I se

                  t out

                  to

                  do

                  bullYesbullYes

                  bullNobullYes

                  bullYesbullNo

                  bullNobullNo

                  Am I having fun nowIs

                  this

                  what

                  I se

                  t out

                  to

                  do

                  bullFunbullOn-task

                  bullNot funbullOn-task

                  bullFunbullNot on-task

                  bullNot funbullNot on-task

                  Key Features of Video Games

                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                  inappropriate behavior ndash never reverse this

                  Key Features of Video Games

                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                  focus groups to determine what really ldquograbs lsquoemrdquo

                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                  Volkow et al 2004

                  Increase salience

                  Increase salience

                  Quarterly QI review

                  The post-mortem

                  Your 1 Organizational Tool

                  Your 1 Organizational Tool

                  Yoga read

                  Staff meeting

                  Planningsession

                  Phone calls

                  billing

                  Your 1 Organizational Tool

                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                  Your 1 Organizational Tool

                  Learn French

                  Stop smoking

                  Be a better spouse

                  The ldquoBig Fiverdquo

                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                  The ldquoBig Fiverdquo

                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                  The ldquoBig Fiverdquo

                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                  The ldquoBig Fiverdquo

                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                  The ldquoBig Fiverdquo

                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                  A CHALLENGEhellip

                  wwwDrNowellcom

                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                  DavidNowellSeminars

                  DavidNowell

                  • Slide 1
                  • hellipa challenge
                  • Slide 3
                  • Perspective of this workshophellip
                  • ldquoTop ndash downrdquo dysfunction
                  • ldquoBottom - uprdquo dysfunction
                  • Slide 7
                  • Whatrsquos the kidrsquos deal
                  • Overview
                  • This Dense Pudding
                  • Sensory Processing Disorder
                  • Slide 12
                  • Slide 13
                  • Developmental considerations
                  • Sensory ProcessingIntegration Disorder and DSM-V
                  • Whatrsquos the kidrsquos deal (2)
                  • Slide 17
                  • Whatrsquos the kidrsquos deal (3)
                  • Slide 19
                  • Strategies
                  • Regulatory-Sensory Processing Disorders
                  • Slide 22
                  • Slide 23
                  • Regulatory-Sensory Processing Disorders (2)
                  • Slide 25
                  • Central Auditory Processing Disorder
                  • Slide 27
                  • Slide 28
                  • Slide 29
                  • Central Auditory Processing Disorder (2)
                  • Central Auditory Processing Disorder (3)
                  • Central Auditory Processing Disorder (4)
                  • CAPD or ADHD
                  • Whatrsquos the kidrsquos deal (4)
                  • Slide 35
                  • Strategies (2)
                  • (C)APD
                  • Treatment for CAPD
                  • Treatment for CAPD (2)
                  • Self-assessment
                  • Attention Deficit Hyperactivity Disorder
                  • Slide 42
                  • Attention Deficit Hyperactivity Disorder (2)
                  • (85 ndash X) x 365
                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                  • Core symptoms
                  • Core symptoms (2)
                  • hellipand the rest of the criteria
                  • Slide 49
                  • Functional impact of core symptoms
                  • Functional impact of core symptoms (2)
                  • Functional impact of core symptoms (3)
                  • Slide 53
                  • Functional impact of core symptoms (4)
                  • Functional impact of core symptoms (5)
                  • Functional impact of core symptoms (6)
                  • Functional impact of core symptoms (7)
                  • Functional impact of core symptoms (8)
                  • Functional impact of core symptoms (9)
                  • Subtypes of ADHD
                  • Subtypes of ADHD (2)
                  • Common comorbidities with ADHD
                  • Slide 63
                  • Common comorbidities with ADHD (2)
                  • ADHD and girls
                  • Slide 66
                  • Slide 67
                  • ADHD and women
                  • Slide 69
                  • ADHD and women (2)
                  • Executive Functioning An Overarching Theme
                  • The Executive Functions
                  • The Executive Functions (2)
                  • Slide 74
                  • Slide 75
                  • Appropriate expectations
                  • Age-appropriate expectations
                  • Age-appropriate expectations (2)
                  • Age-appropriate expectations (3)
                  • Age-appropriate expectations (4)
                  • Age-appropriate expectations (5)
                  • ldquowhat isrdquo vs ldquowhat could berdquo
                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                  • Slide 84
                  • Slide 85
                  • Strategies (3)
                  • Pharmacotherapy
                  • Behavioral Supports
                  • Slide 89
                  • Slide 90
                  • Slide 91
                  • Slide 92
                  • Slide 93
                  • Slide 94
                  • Slide 95
                  • Slide 96
                  • Slide 97
                  • Slide 98
                  • Slide 99
                  • Slide 100
                  • Slide 101
                  • Slide 102
                  • Slide 103
                  • Slide 104
                  • Slide 105
                  • Slide 106
                  • Slide 107
                  • Slide 108
                  • Slide 109
                  • Slide 110
                  • Time Out
                  • Token economy
                  • Slide 113
                  • Slide 114
                  • Slide 115
                  • Intrinsic motivation
                  • Slide 117
                  • Slide 118
                  • Slide 119
                  • Metacognition
                  • ldquoLend Me Your Brainrdquo
                  • What Does Dopamine Feel Like
                  • Preferred States What Does Dopamine Feel Like
                  • Slide 124
                  • PREFERRED STATES INVENTORY
                  • PREFERRED STATES INVENTORY (2)
                  • PREFERRED STATES INVENTORY (3)
                  • Slide 128
                  • Slide 129
                  • Broaden and Build
                  • ldquoNeuroMalleabilityrdquo
                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                  • The reward-and-planning system
                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                  • The reward-and-planning system (2)
                  • Ways the reward-and-planning system can go wrong
                  • Ways the reward-and-planning system can go wrong (2)
                  • Ways the reward-and-planning system can go wrong (3)
                  • Ways the reward-and-planning system can go wrong (4)
                  • Slide 141
                  • Lend Me Your Brain
                  • Ways the reward-and-planning system can go wrong (5)
                  • Ways the reward-and-planning system can go wrong (6)
                  • Ways the reward-and-planning system can go wrong (7)
                  • Slide 146
                  • Ways the reward-and-planning system can go wrong (8)
                  • Ways the reward-and-planning system can go wrong (9)
                  • Slide 149
                  • Ways the reward-and-planning system can go wrong (10)
                  • Ways the reward-and-planning system can go wrong (11)
                  • Slide 152
                  • Ways the reward-and-planning system can go wrong (12)
                  • Slide 154
                  • Ways the reward-and-planning system can go wrong (13)
                  • Ways the reward-and-planning system can go wrong (14)
                  • Slide 157
                  • Slide 158
                  • Slide 159
                  • Ways the reward-and-planning system can go wrong (15)
                  • Ways the reward-and-planning system can go wrong (16)
                  • Slide 162
                  • Ways the reward-and-planning system can go wrong (17)
                  • Slide 164
                  • Instant gratification vs executive gratification
                  • Slide 166
                  • Slide 167
                  • Slide 168
                  • Slide 169
                  • Slide 170
                  • Self-Talk Proficiency
                  • Self-Talk Proficiency (2)
                  • Self-Talk Proficiency (3)
                  • Self-Talk Proficiency (4)
                  • Match the Picture
                  • Slide 176
                  • Slide 177
                  • Distraction Delay Training
                  • Slide 179
                  • Slide 180
                  • Executive Estimates Training
                  • Learning Time
                  • Learning Time (2)
                  • Learning Time (3)
                  • Slide 185
                  • Slide 186
                  • Learning Time (4)
                  • Asking two questionshellip
                  • Slide 189
                  • Slide 190
                  • Key Features of Video Games
                  • Key Features of Video Games (2)
                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                  • Slide 194
                  • Slide 195
                  • Slide 196
                  • Slide 197
                  • Slide 198
                  • Slide 199
                  • Slide 200
                  • Slide 201
                  • Quarterly QI review
                  • The post-mortem
                  • Slide 204
                  • Slide 205
                  • Slide 206
                  • Slide 207
                  • Slide 208
                  • Slide 209
                  • Slide 210
                  • The ldquoBig Fiverdquo
                  • Slide 212
                  • Slide 213
                  • The ldquoBig Fiverdquo (2)
                  • Slide 215
                  • Slide 216
                  • Slide 217
                  • The ldquoBig Fiverdquo (3)
                  • The ldquoBig Fiverdquo (4)
                  • The ldquoBig Fiverdquo (5)
                  • A challengehellip
                  • Slide 222

                    S ensory In tegration

                    S ensory D iscrim ination

                    S ensory M odu lation

                    S ensory D etection

                    Sensory Integration Terminology

                    Sensory Processing

                    Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

                    Sensory ProcessingIntegration Disorder and DSM-V

                    Whatrsquos the kidrsquos deal

                    Whatrsquos the kidrsquos deal

                    Strategies

                    Regulatory-Sensory Processing Disorders

                    Treatment ldquotop downrdquo

                    ldquobottom uprdquo

                    Regulatory-Sensory Processing Disorders

                    Treatment ldquotop downrdquo ldquobottom uprdquo

                    Central Auditory Processing Disorder

                    bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                    Central Auditory Processing Disorder

                    Central Auditory Processing Disorder

                    CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                    Central Auditory Processing Disorder

                    - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                    Central Auditory Processing Disorder

                    - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                    CAPD or ADHD

                    Whatrsquos the kidrsquos deal

                    Strategies

                    (C)APD

                    Treatment ldquotop downrdquo ldquobottom uprdquo

                    X

                    Treatment for CAPD

                    Environmental modifications

                    Treatment for CAPD

                    Compensatory Strategies

                    Self-assessment

                    >

                    Attention Deficit Hyperactivity Disorder

                    Increase salience

                    Attention Deficit Hyperactivity Disorder

                    (85 ndash X) x 365

                    ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                    Core symptoms

                    Inattention distractibility

                    Core symptoms

                    Hyperactivity impulsivity

                    hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                    mental disorder

                    Functional impact of core symptoms

                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                    Functional impact of core symptoms

                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                    Functional impact of core symptoms

                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                    Functional impact of core symptoms

                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                    Functional impact of core symptoms

                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                    Functional impact of core symptoms

                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                    Functional impact of core symptoms

                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                    Functional impact of core symptoms

                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                    Functional impact of core symptoms

                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                    Subtypes of ADHD

                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                    Subtypes of ADHD

                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                    Specifed

                    Common comorbidities with ADHD

                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                    processing challenges

                    Common comorbidities with ADHD

                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                    processing challenges

                    ADHD and girls

                    ADHD and women

                    ADHD and women

                    More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                    partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                    disorganization

                    Executive FunctioningAn Overarching Theme

                    Sensory Processing Disorder Central Auditory Processing

                    Disorder ADHD and Executive Dysfunction

                    The Executive Functions

                    Internalizing speech Previewing

                    Prioritizing Tempo control Inhibition

                    The Executive Functions

                    Determining salience (whatrsquos in it for me)

                    Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                    Appropriate expectations

                    Age-appropriate expectations

                    Preschool 1-step errands Chores with cues Basic inhibition

                    Age-appropriate expectations

                    K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                    3rd ndash 5th

                    Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                    Age-appropriate expectations

                    6th ndash 8th

                    complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                    Age-appropriate expectations

                    Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                    already made Take othersrsquo perspective

                    Age-appropriate expectations

                    ldquowhat isrdquo vs ldquowhat could berdquo

                    ldquowhat isrdquo vs ldquowhat could berdquo

                    Inter-connectedness of systems Cortico-striatal system for example

                    Strategies

                    Pharmacotherapy

                    X

                    Behavioral Supports

                    A B C

                    A B C

                    behavior

                    A B C

                    consequences

                    A B C

                    antecedent

                    A B C

                    A B C

                    antecedent

                    A B C

                    antecedent

                    easy hard

                    A B C

                    consequences

                    R P

                    +

                    -

                    R+ P+

                    R- P-

                    Time Out

                    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                    Token economy

                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                    Intrinsic motivation

                    A B C

                    consequencesX

                    A B C

                    behavior

                    Metacognition

                    Metacognitive knowledge Metacognitive strategies

                    ldquoLend Me Your Brainrdquo

                    What Does Dopamine Feel Like

                    The Physiology of Motivation and Reward

                    Preferred States What Does Dopamine Feel Like

                    1 Great experience2 Kodak moment3 The feeeeling

                    David D Nowell PhD189 May Street

                    Worcester Mass 01602DrNowellcom

                    PREFERRED STATES INVENTORY

                    wwwLulucom

                    Identify 20 peak experiences For each peak experience identify the

                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                    of that moment Name it Check the 20 peak moment-feelings for

                    clusters groupings There will probably be 4 or 5

                    PREFERRED STATES INVENTORY

                    Find a word a label for each of the groupings

                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                    ldquovaluesrdquo ways that you really like to feel

                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                    PREFERRED STATES INVENTORY

                    PREFERRED STATES INVENTORY

                    Broaden and Build

                    ldquoNeuroMalleabilityrdquo

                    Why You Arenrsquot Getting Exactly What You Want All the Time

                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                    The reward-and-planning system

                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                    ldquowhat isrdquo vs ldquowhat could berdquo

                    ldquowhat isrdquo vs ldquowhat could berdquo

                    The reward-and-planning system

                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                    Ways the reward-and-planning system can go wrong

                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                    Ways the reward-and-planning system can go wrong

                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                    Ways the reward-and-planning system can go wrong

                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                    Ways the reward-and-planning system can go wrong

                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                    Lend Me Your Brain

                    Supporting Clients with Executive Dysfunction

                    Ways the reward-and-planning system can go wrong

                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                    Ways the reward-and-planning system can go wrong

                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                    Ways the reward-and-planning system can go wrong

                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                    Ways the reward-and-planning system can go wrong

                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                    Too busy with current activity

                    Field dependent

                    Ways the reward-and-planning system can go wrong

                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                    Ways the reward-and-planning system can go wrong

                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                    Ways the reward-and-planning system can go wrong

                    Sequence problem-solve

                    Ways the reward-and-planning system can go wrong

                    Sequence problem-solve Verbal working memory Nonverbal working memory

                    Ways the reward-and-planning system can go wrong

                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                    Ways the reward-and-planning system can go wrong

                    Block out distractions

                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                    - E Goldberg

                    Ways the reward-and-planning system can go wrong

                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                    Ways the reward-and-planning system can go wrong

                    Get the reward

                    Ways the reward-and-planning system can go wrong

                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                    Instant gratification vs

                    executive gratification

                    A B C

                    behaviorx

                    Self-Talk Proficiency

                    Self-Talk Proficiency

                    bull -ldquoHow are you going to know when to be readyrdquo

                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                    takerdquordquo

                    Self-Talk Proficiency

                    bull -ldquoHow are you going to know what you needrdquo

                    bull -ldquoHow are you going to know what is most importantrdquo

                    bull -ldquoHow are you going to decide what to do firstrdquo

                    bull -ldquoHow will you know when you are donerdquo

                    Self-Talk Proficiency

                    bull -ldquoHow will you continue when you are tiredrdquo

                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                    differentlyrdquo ldquoWho will be the first person to notice

                    thathelliprdquo

                    Match the Picture

                    Distraction Delay Training

                    Executive Estimates Training

                    X

                    Learning Time

                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                    Learning Time

                    Learning Time

                    Learning Time

                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                    Asking two questionshellip

                    Am I having fun now And is this what I set out to do

                    Am I having fun nowIs

                    this

                    what

                    I se

                    t out

                    to

                    do

                    bullYesbullYes

                    bullNobullYes

                    bullYesbullNo

                    bullNobullNo

                    Am I having fun nowIs

                    this

                    what

                    I se

                    t out

                    to

                    do

                    bullFunbullOn-task

                    bullNot funbullOn-task

                    bullFunbullNot on-task

                    bullNot funbullNot on-task

                    Key Features of Video Games

                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                    inappropriate behavior ndash never reverse this

                    Key Features of Video Games

                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                    focus groups to determine what really ldquograbs lsquoemrdquo

                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                    Volkow et al 2004

                    Increase salience

                    Increase salience

                    Quarterly QI review

                    The post-mortem

                    Your 1 Organizational Tool

                    Your 1 Organizational Tool

                    Yoga read

                    Staff meeting

                    Planningsession

                    Phone calls

                    billing

                    Your 1 Organizational Tool

                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                    Your 1 Organizational Tool

                    Learn French

                    Stop smoking

                    Be a better spouse

                    The ldquoBig Fiverdquo

                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                    The ldquoBig Fiverdquo

                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                    The ldquoBig Fiverdquo

                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                    The ldquoBig Fiverdquo

                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                    The ldquoBig Fiverdquo

                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                    A CHALLENGEhellip

                    wwwDrNowellcom

                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                    DavidNowellSeminars

                    DavidNowell

                    • Slide 1
                    • hellipa challenge
                    • Slide 3
                    • Perspective of this workshophellip
                    • ldquoTop ndash downrdquo dysfunction
                    • ldquoBottom - uprdquo dysfunction
                    • Slide 7
                    • Whatrsquos the kidrsquos deal
                    • Overview
                    • This Dense Pudding
                    • Sensory Processing Disorder
                    • Slide 12
                    • Slide 13
                    • Developmental considerations
                    • Sensory ProcessingIntegration Disorder and DSM-V
                    • Whatrsquos the kidrsquos deal (2)
                    • Slide 17
                    • Whatrsquos the kidrsquos deal (3)
                    • Slide 19
                    • Strategies
                    • Regulatory-Sensory Processing Disorders
                    • Slide 22
                    • Slide 23
                    • Regulatory-Sensory Processing Disorders (2)
                    • Slide 25
                    • Central Auditory Processing Disorder
                    • Slide 27
                    • Slide 28
                    • Slide 29
                    • Central Auditory Processing Disorder (2)
                    • Central Auditory Processing Disorder (3)
                    • Central Auditory Processing Disorder (4)
                    • CAPD or ADHD
                    • Whatrsquos the kidrsquos deal (4)
                    • Slide 35
                    • Strategies (2)
                    • (C)APD
                    • Treatment for CAPD
                    • Treatment for CAPD (2)
                    • Self-assessment
                    • Attention Deficit Hyperactivity Disorder
                    • Slide 42
                    • Attention Deficit Hyperactivity Disorder (2)
                    • (85 ndash X) x 365
                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                    • Core symptoms
                    • Core symptoms (2)
                    • hellipand the rest of the criteria
                    • Slide 49
                    • Functional impact of core symptoms
                    • Functional impact of core symptoms (2)
                    • Functional impact of core symptoms (3)
                    • Slide 53
                    • Functional impact of core symptoms (4)
                    • Functional impact of core symptoms (5)
                    • Functional impact of core symptoms (6)
                    • Functional impact of core symptoms (7)
                    • Functional impact of core symptoms (8)
                    • Functional impact of core symptoms (9)
                    • Subtypes of ADHD
                    • Subtypes of ADHD (2)
                    • Common comorbidities with ADHD
                    • Slide 63
                    • Common comorbidities with ADHD (2)
                    • ADHD and girls
                    • Slide 66
                    • Slide 67
                    • ADHD and women
                    • Slide 69
                    • ADHD and women (2)
                    • Executive Functioning An Overarching Theme
                    • The Executive Functions
                    • The Executive Functions (2)
                    • Slide 74
                    • Slide 75
                    • Appropriate expectations
                    • Age-appropriate expectations
                    • Age-appropriate expectations (2)
                    • Age-appropriate expectations (3)
                    • Age-appropriate expectations (4)
                    • Age-appropriate expectations (5)
                    • ldquowhat isrdquo vs ldquowhat could berdquo
                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                    • Slide 84
                    • Slide 85
                    • Strategies (3)
                    • Pharmacotherapy
                    • Behavioral Supports
                    • Slide 89
                    • Slide 90
                    • Slide 91
                    • Slide 92
                    • Slide 93
                    • Slide 94
                    • Slide 95
                    • Slide 96
                    • Slide 97
                    • Slide 98
                    • Slide 99
                    • Slide 100
                    • Slide 101
                    • Slide 102
                    • Slide 103
                    • Slide 104
                    • Slide 105
                    • Slide 106
                    • Slide 107
                    • Slide 108
                    • Slide 109
                    • Slide 110
                    • Time Out
                    • Token economy
                    • Slide 113
                    • Slide 114
                    • Slide 115
                    • Intrinsic motivation
                    • Slide 117
                    • Slide 118
                    • Slide 119
                    • Metacognition
                    • ldquoLend Me Your Brainrdquo
                    • What Does Dopamine Feel Like
                    • Preferred States What Does Dopamine Feel Like
                    • Slide 124
                    • PREFERRED STATES INVENTORY
                    • PREFERRED STATES INVENTORY (2)
                    • PREFERRED STATES INVENTORY (3)
                    • Slide 128
                    • Slide 129
                    • Broaden and Build
                    • ldquoNeuroMalleabilityrdquo
                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                    • The reward-and-planning system
                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                    • The reward-and-planning system (2)
                    • Ways the reward-and-planning system can go wrong
                    • Ways the reward-and-planning system can go wrong (2)
                    • Ways the reward-and-planning system can go wrong (3)
                    • Ways the reward-and-planning system can go wrong (4)
                    • Slide 141
                    • Lend Me Your Brain
                    • Ways the reward-and-planning system can go wrong (5)
                    • Ways the reward-and-planning system can go wrong (6)
                    • Ways the reward-and-planning system can go wrong (7)
                    • Slide 146
                    • Ways the reward-and-planning system can go wrong (8)
                    • Ways the reward-and-planning system can go wrong (9)
                    • Slide 149
                    • Ways the reward-and-planning system can go wrong (10)
                    • Ways the reward-and-planning system can go wrong (11)
                    • Slide 152
                    • Ways the reward-and-planning system can go wrong (12)
                    • Slide 154
                    • Ways the reward-and-planning system can go wrong (13)
                    • Ways the reward-and-planning system can go wrong (14)
                    • Slide 157
                    • Slide 158
                    • Slide 159
                    • Ways the reward-and-planning system can go wrong (15)
                    • Ways the reward-and-planning system can go wrong (16)
                    • Slide 162
                    • Ways the reward-and-planning system can go wrong (17)
                    • Slide 164
                    • Instant gratification vs executive gratification
                    • Slide 166
                    • Slide 167
                    • Slide 168
                    • Slide 169
                    • Slide 170
                    • Self-Talk Proficiency
                    • Self-Talk Proficiency (2)
                    • Self-Talk Proficiency (3)
                    • Self-Talk Proficiency (4)
                    • Match the Picture
                    • Slide 176
                    • Slide 177
                    • Distraction Delay Training
                    • Slide 179
                    • Slide 180
                    • Executive Estimates Training
                    • Learning Time
                    • Learning Time (2)
                    • Learning Time (3)
                    • Slide 185
                    • Slide 186
                    • Learning Time (4)
                    • Asking two questionshellip
                    • Slide 189
                    • Slide 190
                    • Key Features of Video Games
                    • Key Features of Video Games (2)
                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                    • Slide 194
                    • Slide 195
                    • Slide 196
                    • Slide 197
                    • Slide 198
                    • Slide 199
                    • Slide 200
                    • Slide 201
                    • Quarterly QI review
                    • The post-mortem
                    • Slide 204
                    • Slide 205
                    • Slide 206
                    • Slide 207
                    • Slide 208
                    • Slide 209
                    • Slide 210
                    • The ldquoBig Fiverdquo
                    • Slide 212
                    • Slide 213
                    • The ldquoBig Fiverdquo (2)
                    • Slide 215
                    • Slide 216
                    • Slide 217
                    • The ldquoBig Fiverdquo (3)
                    • The ldquoBig Fiverdquo (4)
                    • The ldquoBig Fiverdquo (5)
                    • A challengehellip
                    • Slide 222

                      Developmental considerations Auditory Visual Tactile Proprioceptive Vestibular Motor

                      Sensory ProcessingIntegration Disorder and DSM-V

                      Whatrsquos the kidrsquos deal

                      Whatrsquos the kidrsquos deal

                      Strategies

                      Regulatory-Sensory Processing Disorders

                      Treatment ldquotop downrdquo

                      ldquobottom uprdquo

                      Regulatory-Sensory Processing Disorders

                      Treatment ldquotop downrdquo ldquobottom uprdquo

                      Central Auditory Processing Disorder

                      bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                      Central Auditory Processing Disorder

                      Central Auditory Processing Disorder

                      CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                      Central Auditory Processing Disorder

                      - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                      Central Auditory Processing Disorder

                      - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                      CAPD or ADHD

                      Whatrsquos the kidrsquos deal

                      Strategies

                      (C)APD

                      Treatment ldquotop downrdquo ldquobottom uprdquo

                      X

                      Treatment for CAPD

                      Environmental modifications

                      Treatment for CAPD

                      Compensatory Strategies

                      Self-assessment

                      >

                      Attention Deficit Hyperactivity Disorder

                      Increase salience

                      Attention Deficit Hyperactivity Disorder

                      (85 ndash X) x 365

                      ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                      Core symptoms

                      Inattention distractibility

                      Core symptoms

                      Hyperactivity impulsivity

                      hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                      mental disorder

                      Functional impact of core symptoms

                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                      Functional impact of core symptoms

                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                      Functional impact of core symptoms

                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                      Functional impact of core symptoms

                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                      Functional impact of core symptoms

                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                      Functional impact of core symptoms

                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                      Functional impact of core symptoms

                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                      Functional impact of core symptoms

                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                      Functional impact of core symptoms

                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                      Subtypes of ADHD

                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                      Subtypes of ADHD

                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                      Specifed

                      Common comorbidities with ADHD

                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                      processing challenges

                      Common comorbidities with ADHD

                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                      processing challenges

                      ADHD and girls

                      ADHD and women

                      ADHD and women

                      More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                      partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                      disorganization

                      Executive FunctioningAn Overarching Theme

                      Sensory Processing Disorder Central Auditory Processing

                      Disorder ADHD and Executive Dysfunction

                      The Executive Functions

                      Internalizing speech Previewing

                      Prioritizing Tempo control Inhibition

                      The Executive Functions

                      Determining salience (whatrsquos in it for me)

                      Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                      Appropriate expectations

                      Age-appropriate expectations

                      Preschool 1-step errands Chores with cues Basic inhibition

                      Age-appropriate expectations

                      K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                      3rd ndash 5th

                      Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                      Age-appropriate expectations

                      6th ndash 8th

                      complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                      Age-appropriate expectations

                      Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                      already made Take othersrsquo perspective

                      Age-appropriate expectations

                      ldquowhat isrdquo vs ldquowhat could berdquo

                      ldquowhat isrdquo vs ldquowhat could berdquo

                      Inter-connectedness of systems Cortico-striatal system for example

                      Strategies

                      Pharmacotherapy

                      X

                      Behavioral Supports

                      A B C

                      A B C

                      behavior

                      A B C

                      consequences

                      A B C

                      antecedent

                      A B C

                      A B C

                      antecedent

                      A B C

                      antecedent

                      easy hard

                      A B C

                      consequences

                      R P

                      +

                      -

                      R+ P+

                      R- P-

                      Time Out

                      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                      Token economy

                      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                      Intrinsic motivation

                      A B C

                      consequencesX

                      A B C

                      behavior

                      Metacognition

                      Metacognitive knowledge Metacognitive strategies

                      ldquoLend Me Your Brainrdquo

                      What Does Dopamine Feel Like

                      The Physiology of Motivation and Reward

                      Preferred States What Does Dopamine Feel Like

                      1 Great experience2 Kodak moment3 The feeeeling

                      David D Nowell PhD189 May Street

                      Worcester Mass 01602DrNowellcom

                      PREFERRED STATES INVENTORY

                      wwwLulucom

                      Identify 20 peak experiences For each peak experience identify the

                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                      of that moment Name it Check the 20 peak moment-feelings for

                      clusters groupings There will probably be 4 or 5

                      PREFERRED STATES INVENTORY

                      Find a word a label for each of the groupings

                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                      ldquovaluesrdquo ways that you really like to feel

                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                      PREFERRED STATES INVENTORY

                      PREFERRED STATES INVENTORY

                      Broaden and Build

                      ldquoNeuroMalleabilityrdquo

                      Why You Arenrsquot Getting Exactly What You Want All the Time

                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                      The reward-and-planning system

                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                      ldquowhat isrdquo vs ldquowhat could berdquo

                      ldquowhat isrdquo vs ldquowhat could berdquo

                      The reward-and-planning system

                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                      Ways the reward-and-planning system can go wrong

                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                      Ways the reward-and-planning system can go wrong

                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                      Ways the reward-and-planning system can go wrong

                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                      Ways the reward-and-planning system can go wrong

                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                      Lend Me Your Brain

                      Supporting Clients with Executive Dysfunction

                      Ways the reward-and-planning system can go wrong

                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                      Ways the reward-and-planning system can go wrong

                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                      Ways the reward-and-planning system can go wrong

                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                      Ways the reward-and-planning system can go wrong

                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                      Too busy with current activity

                      Field dependent

                      Ways the reward-and-planning system can go wrong

                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                      Ways the reward-and-planning system can go wrong

                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                      Ways the reward-and-planning system can go wrong

                      Sequence problem-solve

                      Ways the reward-and-planning system can go wrong

                      Sequence problem-solve Verbal working memory Nonverbal working memory

                      Ways the reward-and-planning system can go wrong

                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                      Ways the reward-and-planning system can go wrong

                      Block out distractions

                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                      - E Goldberg

                      Ways the reward-and-planning system can go wrong

                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                      Ways the reward-and-planning system can go wrong

                      Get the reward

                      Ways the reward-and-planning system can go wrong

                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                      Instant gratification vs

                      executive gratification

                      A B C

                      behaviorx

                      Self-Talk Proficiency

                      Self-Talk Proficiency

                      bull -ldquoHow are you going to know when to be readyrdquo

                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                      takerdquordquo

                      Self-Talk Proficiency

                      bull -ldquoHow are you going to know what you needrdquo

                      bull -ldquoHow are you going to know what is most importantrdquo

                      bull -ldquoHow are you going to decide what to do firstrdquo

                      bull -ldquoHow will you know when you are donerdquo

                      Self-Talk Proficiency

                      bull -ldquoHow will you continue when you are tiredrdquo

                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                      differentlyrdquo ldquoWho will be the first person to notice

                      thathelliprdquo

                      Match the Picture

                      Distraction Delay Training

                      Executive Estimates Training

                      X

                      Learning Time

                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                      Learning Time

                      Learning Time

                      Learning Time

                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                      Asking two questionshellip

                      Am I having fun now And is this what I set out to do

                      Am I having fun nowIs

                      this

                      what

                      I se

                      t out

                      to

                      do

                      bullYesbullYes

                      bullNobullYes

                      bullYesbullNo

                      bullNobullNo

                      Am I having fun nowIs

                      this

                      what

                      I se

                      t out

                      to

                      do

                      bullFunbullOn-task

                      bullNot funbullOn-task

                      bullFunbullNot on-task

                      bullNot funbullNot on-task

                      Key Features of Video Games

                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                      inappropriate behavior ndash never reverse this

                      Key Features of Video Games

                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                      focus groups to determine what really ldquograbs lsquoemrdquo

                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                      Volkow et al 2004

                      Increase salience

                      Increase salience

                      Quarterly QI review

                      The post-mortem

                      Your 1 Organizational Tool

                      Your 1 Organizational Tool

                      Yoga read

                      Staff meeting

                      Planningsession

                      Phone calls

                      billing

                      Your 1 Organizational Tool

                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                      Your 1 Organizational Tool

                      Learn French

                      Stop smoking

                      Be a better spouse

                      The ldquoBig Fiverdquo

                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                      The ldquoBig Fiverdquo

                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                      The ldquoBig Fiverdquo

                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                      The ldquoBig Fiverdquo

                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                      The ldquoBig Fiverdquo

                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                      A CHALLENGEhellip

                      wwwDrNowellcom

                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                      DavidNowellSeminars

                      DavidNowell

                      • Slide 1
                      • hellipa challenge
                      • Slide 3
                      • Perspective of this workshophellip
                      • ldquoTop ndash downrdquo dysfunction
                      • ldquoBottom - uprdquo dysfunction
                      • Slide 7
                      • Whatrsquos the kidrsquos deal
                      • Overview
                      • This Dense Pudding
                      • Sensory Processing Disorder
                      • Slide 12
                      • Slide 13
                      • Developmental considerations
                      • Sensory ProcessingIntegration Disorder and DSM-V
                      • Whatrsquos the kidrsquos deal (2)
                      • Slide 17
                      • Whatrsquos the kidrsquos deal (3)
                      • Slide 19
                      • Strategies
                      • Regulatory-Sensory Processing Disorders
                      • Slide 22
                      • Slide 23
                      • Regulatory-Sensory Processing Disorders (2)
                      • Slide 25
                      • Central Auditory Processing Disorder
                      • Slide 27
                      • Slide 28
                      • Slide 29
                      • Central Auditory Processing Disorder (2)
                      • Central Auditory Processing Disorder (3)
                      • Central Auditory Processing Disorder (4)
                      • CAPD or ADHD
                      • Whatrsquos the kidrsquos deal (4)
                      • Slide 35
                      • Strategies (2)
                      • (C)APD
                      • Treatment for CAPD
                      • Treatment for CAPD (2)
                      • Self-assessment
                      • Attention Deficit Hyperactivity Disorder
                      • Slide 42
                      • Attention Deficit Hyperactivity Disorder (2)
                      • (85 ndash X) x 365
                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                      • Core symptoms
                      • Core symptoms (2)
                      • hellipand the rest of the criteria
                      • Slide 49
                      • Functional impact of core symptoms
                      • Functional impact of core symptoms (2)
                      • Functional impact of core symptoms (3)
                      • Slide 53
                      • Functional impact of core symptoms (4)
                      • Functional impact of core symptoms (5)
                      • Functional impact of core symptoms (6)
                      • Functional impact of core symptoms (7)
                      • Functional impact of core symptoms (8)
                      • Functional impact of core symptoms (9)
                      • Subtypes of ADHD
                      • Subtypes of ADHD (2)
                      • Common comorbidities with ADHD
                      • Slide 63
                      • Common comorbidities with ADHD (2)
                      • ADHD and girls
                      • Slide 66
                      • Slide 67
                      • ADHD and women
                      • Slide 69
                      • ADHD and women (2)
                      • Executive Functioning An Overarching Theme
                      • The Executive Functions
                      • The Executive Functions (2)
                      • Slide 74
                      • Slide 75
                      • Appropriate expectations
                      • Age-appropriate expectations
                      • Age-appropriate expectations (2)
                      • Age-appropriate expectations (3)
                      • Age-appropriate expectations (4)
                      • Age-appropriate expectations (5)
                      • ldquowhat isrdquo vs ldquowhat could berdquo
                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                      • Slide 84
                      • Slide 85
                      • Strategies (3)
                      • Pharmacotherapy
                      • Behavioral Supports
                      • Slide 89
                      • Slide 90
                      • Slide 91
                      • Slide 92
                      • Slide 93
                      • Slide 94
                      • Slide 95
                      • Slide 96
                      • Slide 97
                      • Slide 98
                      • Slide 99
                      • Slide 100
                      • Slide 101
                      • Slide 102
                      • Slide 103
                      • Slide 104
                      • Slide 105
                      • Slide 106
                      • Slide 107
                      • Slide 108
                      • Slide 109
                      • Slide 110
                      • Time Out
                      • Token economy
                      • Slide 113
                      • Slide 114
                      • Slide 115
                      • Intrinsic motivation
                      • Slide 117
                      • Slide 118
                      • Slide 119
                      • Metacognition
                      • ldquoLend Me Your Brainrdquo
                      • What Does Dopamine Feel Like
                      • Preferred States What Does Dopamine Feel Like
                      • Slide 124
                      • PREFERRED STATES INVENTORY
                      • PREFERRED STATES INVENTORY (2)
                      • PREFERRED STATES INVENTORY (3)
                      • Slide 128
                      • Slide 129
                      • Broaden and Build
                      • ldquoNeuroMalleabilityrdquo
                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                      • The reward-and-planning system
                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                      • The reward-and-planning system (2)
                      • Ways the reward-and-planning system can go wrong
                      • Ways the reward-and-planning system can go wrong (2)
                      • Ways the reward-and-planning system can go wrong (3)
                      • Ways the reward-and-planning system can go wrong (4)
                      • Slide 141
                      • Lend Me Your Brain
                      • Ways the reward-and-planning system can go wrong (5)
                      • Ways the reward-and-planning system can go wrong (6)
                      • Ways the reward-and-planning system can go wrong (7)
                      • Slide 146
                      • Ways the reward-and-planning system can go wrong (8)
                      • Ways the reward-and-planning system can go wrong (9)
                      • Slide 149
                      • Ways the reward-and-planning system can go wrong (10)
                      • Ways the reward-and-planning system can go wrong (11)
                      • Slide 152
                      • Ways the reward-and-planning system can go wrong (12)
                      • Slide 154
                      • Ways the reward-and-planning system can go wrong (13)
                      • Ways the reward-and-planning system can go wrong (14)
                      • Slide 157
                      • Slide 158
                      • Slide 159
                      • Ways the reward-and-planning system can go wrong (15)
                      • Ways the reward-and-planning system can go wrong (16)
                      • Slide 162
                      • Ways the reward-and-planning system can go wrong (17)
                      • Slide 164
                      • Instant gratification vs executive gratification
                      • Slide 166
                      • Slide 167
                      • Slide 168
                      • Slide 169
                      • Slide 170
                      • Self-Talk Proficiency
                      • Self-Talk Proficiency (2)
                      • Self-Talk Proficiency (3)
                      • Self-Talk Proficiency (4)
                      • Match the Picture
                      • Slide 176
                      • Slide 177
                      • Distraction Delay Training
                      • Slide 179
                      • Slide 180
                      • Executive Estimates Training
                      • Learning Time
                      • Learning Time (2)
                      • Learning Time (3)
                      • Slide 185
                      • Slide 186
                      • Learning Time (4)
                      • Asking two questionshellip
                      • Slide 189
                      • Slide 190
                      • Key Features of Video Games
                      • Key Features of Video Games (2)
                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                      • Slide 194
                      • Slide 195
                      • Slide 196
                      • Slide 197
                      • Slide 198
                      • Slide 199
                      • Slide 200
                      • Slide 201
                      • Quarterly QI review
                      • The post-mortem
                      • Slide 204
                      • Slide 205
                      • Slide 206
                      • Slide 207
                      • Slide 208
                      • Slide 209
                      • Slide 210
                      • The ldquoBig Fiverdquo
                      • Slide 212
                      • Slide 213
                      • The ldquoBig Fiverdquo (2)
                      • Slide 215
                      • Slide 216
                      • Slide 217
                      • The ldquoBig Fiverdquo (3)
                      • The ldquoBig Fiverdquo (4)
                      • The ldquoBig Fiverdquo (5)
                      • A challengehellip
                      • Slide 222

                        Sensory ProcessingIntegration Disorder and DSM-V

                        Whatrsquos the kidrsquos deal

                        Whatrsquos the kidrsquos deal

                        Strategies

                        Regulatory-Sensory Processing Disorders

                        Treatment ldquotop downrdquo

                        ldquobottom uprdquo

                        Regulatory-Sensory Processing Disorders

                        Treatment ldquotop downrdquo ldquobottom uprdquo

                        Central Auditory Processing Disorder

                        bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                        Central Auditory Processing Disorder

                        Central Auditory Processing Disorder

                        CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                        Central Auditory Processing Disorder

                        - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                        Central Auditory Processing Disorder

                        - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                        CAPD or ADHD

                        Whatrsquos the kidrsquos deal

                        Strategies

                        (C)APD

                        Treatment ldquotop downrdquo ldquobottom uprdquo

                        X

                        Treatment for CAPD

                        Environmental modifications

                        Treatment for CAPD

                        Compensatory Strategies

                        Self-assessment

                        >

                        Attention Deficit Hyperactivity Disorder

                        Increase salience

                        Attention Deficit Hyperactivity Disorder

                        (85 ndash X) x 365

                        ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                        Core symptoms

                        Inattention distractibility

                        Core symptoms

                        Hyperactivity impulsivity

                        hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                        mental disorder

                        Functional impact of core symptoms

                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                        Functional impact of core symptoms

                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                        Functional impact of core symptoms

                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                        Functional impact of core symptoms

                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                        Functional impact of core symptoms

                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                        Functional impact of core symptoms

                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                        Functional impact of core symptoms

                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                        Functional impact of core symptoms

                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                        Functional impact of core symptoms

                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                        Subtypes of ADHD

                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                        Subtypes of ADHD

                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                        Specifed

                        Common comorbidities with ADHD

                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                        processing challenges

                        Common comorbidities with ADHD

                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                        processing challenges

                        ADHD and girls

                        ADHD and women

                        ADHD and women

                        More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                        partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                        disorganization

                        Executive FunctioningAn Overarching Theme

                        Sensory Processing Disorder Central Auditory Processing

                        Disorder ADHD and Executive Dysfunction

                        The Executive Functions

                        Internalizing speech Previewing

                        Prioritizing Tempo control Inhibition

                        The Executive Functions

                        Determining salience (whatrsquos in it for me)

                        Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                        Appropriate expectations

                        Age-appropriate expectations

                        Preschool 1-step errands Chores with cues Basic inhibition

                        Age-appropriate expectations

                        K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                        3rd ndash 5th

                        Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                        Age-appropriate expectations

                        6th ndash 8th

                        complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                        Age-appropriate expectations

                        Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                        already made Take othersrsquo perspective

                        Age-appropriate expectations

                        ldquowhat isrdquo vs ldquowhat could berdquo

                        ldquowhat isrdquo vs ldquowhat could berdquo

                        Inter-connectedness of systems Cortico-striatal system for example

                        Strategies

                        Pharmacotherapy

                        X

                        Behavioral Supports

                        A B C

                        A B C

                        behavior

                        A B C

                        consequences

                        A B C

                        antecedent

                        A B C

                        A B C

                        antecedent

                        A B C

                        antecedent

                        easy hard

                        A B C

                        consequences

                        R P

                        +

                        -

                        R+ P+

                        R- P-

                        Time Out

                        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                        Token economy

                        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                        Intrinsic motivation

                        A B C

                        consequencesX

                        A B C

                        behavior

                        Metacognition

                        Metacognitive knowledge Metacognitive strategies

                        ldquoLend Me Your Brainrdquo

                        What Does Dopamine Feel Like

                        The Physiology of Motivation and Reward

                        Preferred States What Does Dopamine Feel Like

                        1 Great experience2 Kodak moment3 The feeeeling

                        David D Nowell PhD189 May Street

                        Worcester Mass 01602DrNowellcom

                        PREFERRED STATES INVENTORY

                        wwwLulucom

                        Identify 20 peak experiences For each peak experience identify the

                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                        of that moment Name it Check the 20 peak moment-feelings for

                        clusters groupings There will probably be 4 or 5

                        PREFERRED STATES INVENTORY

                        Find a word a label for each of the groupings

                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                        ldquovaluesrdquo ways that you really like to feel

                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                        PREFERRED STATES INVENTORY

                        PREFERRED STATES INVENTORY

                        Broaden and Build

                        ldquoNeuroMalleabilityrdquo

                        Why You Arenrsquot Getting Exactly What You Want All the Time

                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                        The reward-and-planning system

                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                        ldquowhat isrdquo vs ldquowhat could berdquo

                        ldquowhat isrdquo vs ldquowhat could berdquo

                        The reward-and-planning system

                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                        Ways the reward-and-planning system can go wrong

                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                        Ways the reward-and-planning system can go wrong

                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                        Ways the reward-and-planning system can go wrong

                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                        Ways the reward-and-planning system can go wrong

                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                        Lend Me Your Brain

                        Supporting Clients with Executive Dysfunction

                        Ways the reward-and-planning system can go wrong

                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                        Ways the reward-and-planning system can go wrong

                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                        Ways the reward-and-planning system can go wrong

                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                        Ways the reward-and-planning system can go wrong

                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                        Too busy with current activity

                        Field dependent

                        Ways the reward-and-planning system can go wrong

                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                        Ways the reward-and-planning system can go wrong

                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                        Ways the reward-and-planning system can go wrong

                        Sequence problem-solve

                        Ways the reward-and-planning system can go wrong

                        Sequence problem-solve Verbal working memory Nonverbal working memory

                        Ways the reward-and-planning system can go wrong

                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                        Ways the reward-and-planning system can go wrong

                        Block out distractions

                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                        - E Goldberg

                        Ways the reward-and-planning system can go wrong

                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                        Ways the reward-and-planning system can go wrong

                        Get the reward

                        Ways the reward-and-planning system can go wrong

                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                        Instant gratification vs

                        executive gratification

                        A B C

                        behaviorx

                        Self-Talk Proficiency

                        Self-Talk Proficiency

                        bull -ldquoHow are you going to know when to be readyrdquo

                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                        takerdquordquo

                        Self-Talk Proficiency

                        bull -ldquoHow are you going to know what you needrdquo

                        bull -ldquoHow are you going to know what is most importantrdquo

                        bull -ldquoHow are you going to decide what to do firstrdquo

                        bull -ldquoHow will you know when you are donerdquo

                        Self-Talk Proficiency

                        bull -ldquoHow will you continue when you are tiredrdquo

                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                        differentlyrdquo ldquoWho will be the first person to notice

                        thathelliprdquo

                        Match the Picture

                        Distraction Delay Training

                        Executive Estimates Training

                        X

                        Learning Time

                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                        Learning Time

                        Learning Time

                        Learning Time

                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                        Asking two questionshellip

                        Am I having fun now And is this what I set out to do

                        Am I having fun nowIs

                        this

                        what

                        I se

                        t out

                        to

                        do

                        bullYesbullYes

                        bullNobullYes

                        bullYesbullNo

                        bullNobullNo

                        Am I having fun nowIs

                        this

                        what

                        I se

                        t out

                        to

                        do

                        bullFunbullOn-task

                        bullNot funbullOn-task

                        bullFunbullNot on-task

                        bullNot funbullNot on-task

                        Key Features of Video Games

                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                        inappropriate behavior ndash never reverse this

                        Key Features of Video Games

                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                        focus groups to determine what really ldquograbs lsquoemrdquo

                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                        Volkow et al 2004

                        Increase salience

                        Increase salience

                        Quarterly QI review

                        The post-mortem

                        Your 1 Organizational Tool

                        Your 1 Organizational Tool

                        Yoga read

                        Staff meeting

                        Planningsession

                        Phone calls

                        billing

                        Your 1 Organizational Tool

                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                        Your 1 Organizational Tool

                        Learn French

                        Stop smoking

                        Be a better spouse

                        The ldquoBig Fiverdquo

                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                        The ldquoBig Fiverdquo

                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                        The ldquoBig Fiverdquo

                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                        The ldquoBig Fiverdquo

                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                        The ldquoBig Fiverdquo

                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                        A CHALLENGEhellip

                        wwwDrNowellcom

                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                        DavidNowellSeminars

                        DavidNowell

                        • Slide 1
                        • hellipa challenge
                        • Slide 3
                        • Perspective of this workshophellip
                        • ldquoTop ndash downrdquo dysfunction
                        • ldquoBottom - uprdquo dysfunction
                        • Slide 7
                        • Whatrsquos the kidrsquos deal
                        • Overview
                        • This Dense Pudding
                        • Sensory Processing Disorder
                        • Slide 12
                        • Slide 13
                        • Developmental considerations
                        • Sensory ProcessingIntegration Disorder and DSM-V
                        • Whatrsquos the kidrsquos deal (2)
                        • Slide 17
                        • Whatrsquos the kidrsquos deal (3)
                        • Slide 19
                        • Strategies
                        • Regulatory-Sensory Processing Disorders
                        • Slide 22
                        • Slide 23
                        • Regulatory-Sensory Processing Disorders (2)
                        • Slide 25
                        • Central Auditory Processing Disorder
                        • Slide 27
                        • Slide 28
                        • Slide 29
                        • Central Auditory Processing Disorder (2)
                        • Central Auditory Processing Disorder (3)
                        • Central Auditory Processing Disorder (4)
                        • CAPD or ADHD
                        • Whatrsquos the kidrsquos deal (4)
                        • Slide 35
                        • Strategies (2)
                        • (C)APD
                        • Treatment for CAPD
                        • Treatment for CAPD (2)
                        • Self-assessment
                        • Attention Deficit Hyperactivity Disorder
                        • Slide 42
                        • Attention Deficit Hyperactivity Disorder (2)
                        • (85 ndash X) x 365
                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                        • Core symptoms
                        • Core symptoms (2)
                        • hellipand the rest of the criteria
                        • Slide 49
                        • Functional impact of core symptoms
                        • Functional impact of core symptoms (2)
                        • Functional impact of core symptoms (3)
                        • Slide 53
                        • Functional impact of core symptoms (4)
                        • Functional impact of core symptoms (5)
                        • Functional impact of core symptoms (6)
                        • Functional impact of core symptoms (7)
                        • Functional impact of core symptoms (8)
                        • Functional impact of core symptoms (9)
                        • Subtypes of ADHD
                        • Subtypes of ADHD (2)
                        • Common comorbidities with ADHD
                        • Slide 63
                        • Common comorbidities with ADHD (2)
                        • ADHD and girls
                        • Slide 66
                        • Slide 67
                        • ADHD and women
                        • Slide 69
                        • ADHD and women (2)
                        • Executive Functioning An Overarching Theme
                        • The Executive Functions
                        • The Executive Functions (2)
                        • Slide 74
                        • Slide 75
                        • Appropriate expectations
                        • Age-appropriate expectations
                        • Age-appropriate expectations (2)
                        • Age-appropriate expectations (3)
                        • Age-appropriate expectations (4)
                        • Age-appropriate expectations (5)
                        • ldquowhat isrdquo vs ldquowhat could berdquo
                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                        • Slide 84
                        • Slide 85
                        • Strategies (3)
                        • Pharmacotherapy
                        • Behavioral Supports
                        • Slide 89
                        • Slide 90
                        • Slide 91
                        • Slide 92
                        • Slide 93
                        • Slide 94
                        • Slide 95
                        • Slide 96
                        • Slide 97
                        • Slide 98
                        • Slide 99
                        • Slide 100
                        • Slide 101
                        • Slide 102
                        • Slide 103
                        • Slide 104
                        • Slide 105
                        • Slide 106
                        • Slide 107
                        • Slide 108
                        • Slide 109
                        • Slide 110
                        • Time Out
                        • Token economy
                        • Slide 113
                        • Slide 114
                        • Slide 115
                        • Intrinsic motivation
                        • Slide 117
                        • Slide 118
                        • Slide 119
                        • Metacognition
                        • ldquoLend Me Your Brainrdquo
                        • What Does Dopamine Feel Like
                        • Preferred States What Does Dopamine Feel Like
                        • Slide 124
                        • PREFERRED STATES INVENTORY
                        • PREFERRED STATES INVENTORY (2)
                        • PREFERRED STATES INVENTORY (3)
                        • Slide 128
                        • Slide 129
                        • Broaden and Build
                        • ldquoNeuroMalleabilityrdquo
                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                        • The reward-and-planning system
                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                        • The reward-and-planning system (2)
                        • Ways the reward-and-planning system can go wrong
                        • Ways the reward-and-planning system can go wrong (2)
                        • Ways the reward-and-planning system can go wrong (3)
                        • Ways the reward-and-planning system can go wrong (4)
                        • Slide 141
                        • Lend Me Your Brain
                        • Ways the reward-and-planning system can go wrong (5)
                        • Ways the reward-and-planning system can go wrong (6)
                        • Ways the reward-and-planning system can go wrong (7)
                        • Slide 146
                        • Ways the reward-and-planning system can go wrong (8)
                        • Ways the reward-and-planning system can go wrong (9)
                        • Slide 149
                        • Ways the reward-and-planning system can go wrong (10)
                        • Ways the reward-and-planning system can go wrong (11)
                        • Slide 152
                        • Ways the reward-and-planning system can go wrong (12)
                        • Slide 154
                        • Ways the reward-and-planning system can go wrong (13)
                        • Ways the reward-and-planning system can go wrong (14)
                        • Slide 157
                        • Slide 158
                        • Slide 159
                        • Ways the reward-and-planning system can go wrong (15)
                        • Ways the reward-and-planning system can go wrong (16)
                        • Slide 162
                        • Ways the reward-and-planning system can go wrong (17)
                        • Slide 164
                        • Instant gratification vs executive gratification
                        • Slide 166
                        • Slide 167
                        • Slide 168
                        • Slide 169
                        • Slide 170
                        • Self-Talk Proficiency
                        • Self-Talk Proficiency (2)
                        • Self-Talk Proficiency (3)
                        • Self-Talk Proficiency (4)
                        • Match the Picture
                        • Slide 176
                        • Slide 177
                        • Distraction Delay Training
                        • Slide 179
                        • Slide 180
                        • Executive Estimates Training
                        • Learning Time
                        • Learning Time (2)
                        • Learning Time (3)
                        • Slide 185
                        • Slide 186
                        • Learning Time (4)
                        • Asking two questionshellip
                        • Slide 189
                        • Slide 190
                        • Key Features of Video Games
                        • Key Features of Video Games (2)
                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                        • Slide 194
                        • Slide 195
                        • Slide 196
                        • Slide 197
                        • Slide 198
                        • Slide 199
                        • Slide 200
                        • Slide 201
                        • Quarterly QI review
                        • The post-mortem
                        • Slide 204
                        • Slide 205
                        • Slide 206
                        • Slide 207
                        • Slide 208
                        • Slide 209
                        • Slide 210
                        • The ldquoBig Fiverdquo
                        • Slide 212
                        • Slide 213
                        • The ldquoBig Fiverdquo (2)
                        • Slide 215
                        • Slide 216
                        • Slide 217
                        • The ldquoBig Fiverdquo (3)
                        • The ldquoBig Fiverdquo (4)
                        • The ldquoBig Fiverdquo (5)
                        • A challengehellip
                        • Slide 222

                          Whatrsquos the kidrsquos deal

                          Whatrsquos the kidrsquos deal

                          Strategies

                          Regulatory-Sensory Processing Disorders

                          Treatment ldquotop downrdquo

                          ldquobottom uprdquo

                          Regulatory-Sensory Processing Disorders

                          Treatment ldquotop downrdquo ldquobottom uprdquo

                          Central Auditory Processing Disorder

                          bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                          Central Auditory Processing Disorder

                          Central Auditory Processing Disorder

                          CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                          Central Auditory Processing Disorder

                          - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                          Central Auditory Processing Disorder

                          - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                          CAPD or ADHD

                          Whatrsquos the kidrsquos deal

                          Strategies

                          (C)APD

                          Treatment ldquotop downrdquo ldquobottom uprdquo

                          X

                          Treatment for CAPD

                          Environmental modifications

                          Treatment for CAPD

                          Compensatory Strategies

                          Self-assessment

                          >

                          Attention Deficit Hyperactivity Disorder

                          Increase salience

                          Attention Deficit Hyperactivity Disorder

                          (85 ndash X) x 365

                          ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                          Core symptoms

                          Inattention distractibility

                          Core symptoms

                          Hyperactivity impulsivity

                          hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                          mental disorder

                          Functional impact of core symptoms

                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                          Functional impact of core symptoms

                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                          Functional impact of core symptoms

                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                          Functional impact of core symptoms

                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                          Functional impact of core symptoms

                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                          Functional impact of core symptoms

                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                          Functional impact of core symptoms

                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                          Functional impact of core symptoms

                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                          Functional impact of core symptoms

                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                          Subtypes of ADHD

                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                          Subtypes of ADHD

                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                          Specifed

                          Common comorbidities with ADHD

                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                          processing challenges

                          Common comorbidities with ADHD

                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                          processing challenges

                          ADHD and girls

                          ADHD and women

                          ADHD and women

                          More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                          partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                          disorganization

                          Executive FunctioningAn Overarching Theme

                          Sensory Processing Disorder Central Auditory Processing

                          Disorder ADHD and Executive Dysfunction

                          The Executive Functions

                          Internalizing speech Previewing

                          Prioritizing Tempo control Inhibition

                          The Executive Functions

                          Determining salience (whatrsquos in it for me)

                          Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                          Appropriate expectations

                          Age-appropriate expectations

                          Preschool 1-step errands Chores with cues Basic inhibition

                          Age-appropriate expectations

                          K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                          3rd ndash 5th

                          Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                          Age-appropriate expectations

                          6th ndash 8th

                          complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                          Age-appropriate expectations

                          Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                          already made Take othersrsquo perspective

                          Age-appropriate expectations

                          ldquowhat isrdquo vs ldquowhat could berdquo

                          ldquowhat isrdquo vs ldquowhat could berdquo

                          Inter-connectedness of systems Cortico-striatal system for example

                          Strategies

                          Pharmacotherapy

                          X

                          Behavioral Supports

                          A B C

                          A B C

                          behavior

                          A B C

                          consequences

                          A B C

                          antecedent

                          A B C

                          A B C

                          antecedent

                          A B C

                          antecedent

                          easy hard

                          A B C

                          consequences

                          R P

                          +

                          -

                          R+ P+

                          R- P-

                          Time Out

                          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                          Token economy

                          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                          Intrinsic motivation

                          A B C

                          consequencesX

                          A B C

                          behavior

                          Metacognition

                          Metacognitive knowledge Metacognitive strategies

                          ldquoLend Me Your Brainrdquo

                          What Does Dopamine Feel Like

                          The Physiology of Motivation and Reward

                          Preferred States What Does Dopamine Feel Like

                          1 Great experience2 Kodak moment3 The feeeeling

                          David D Nowell PhD189 May Street

                          Worcester Mass 01602DrNowellcom

                          PREFERRED STATES INVENTORY

                          wwwLulucom

                          Identify 20 peak experiences For each peak experience identify the

                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                          of that moment Name it Check the 20 peak moment-feelings for

                          clusters groupings There will probably be 4 or 5

                          PREFERRED STATES INVENTORY

                          Find a word a label for each of the groupings

                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                          ldquovaluesrdquo ways that you really like to feel

                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                          PREFERRED STATES INVENTORY

                          PREFERRED STATES INVENTORY

                          Broaden and Build

                          ldquoNeuroMalleabilityrdquo

                          Why You Arenrsquot Getting Exactly What You Want All the Time

                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                          The reward-and-planning system

                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                          ldquowhat isrdquo vs ldquowhat could berdquo

                          ldquowhat isrdquo vs ldquowhat could berdquo

                          The reward-and-planning system

                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                          Ways the reward-and-planning system can go wrong

                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                          Ways the reward-and-planning system can go wrong

                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                          Ways the reward-and-planning system can go wrong

                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                          Ways the reward-and-planning system can go wrong

                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                          Lend Me Your Brain

                          Supporting Clients with Executive Dysfunction

                          Ways the reward-and-planning system can go wrong

                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                          Ways the reward-and-planning system can go wrong

                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                          Ways the reward-and-planning system can go wrong

                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                          Ways the reward-and-planning system can go wrong

                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                          Too busy with current activity

                          Field dependent

                          Ways the reward-and-planning system can go wrong

                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                          Ways the reward-and-planning system can go wrong

                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                          Ways the reward-and-planning system can go wrong

                          Sequence problem-solve

                          Ways the reward-and-planning system can go wrong

                          Sequence problem-solve Verbal working memory Nonverbal working memory

                          Ways the reward-and-planning system can go wrong

                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                          Ways the reward-and-planning system can go wrong

                          Block out distractions

                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                          - E Goldberg

                          Ways the reward-and-planning system can go wrong

                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                          Ways the reward-and-planning system can go wrong

                          Get the reward

                          Ways the reward-and-planning system can go wrong

                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                          Instant gratification vs

                          executive gratification

                          A B C

                          behaviorx

                          Self-Talk Proficiency

                          Self-Talk Proficiency

                          bull -ldquoHow are you going to know when to be readyrdquo

                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                          takerdquordquo

                          Self-Talk Proficiency

                          bull -ldquoHow are you going to know what you needrdquo

                          bull -ldquoHow are you going to know what is most importantrdquo

                          bull -ldquoHow are you going to decide what to do firstrdquo

                          bull -ldquoHow will you know when you are donerdquo

                          Self-Talk Proficiency

                          bull -ldquoHow will you continue when you are tiredrdquo

                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                          differentlyrdquo ldquoWho will be the first person to notice

                          thathelliprdquo

                          Match the Picture

                          Distraction Delay Training

                          Executive Estimates Training

                          X

                          Learning Time

                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                          Learning Time

                          Learning Time

                          Learning Time

                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                          Asking two questionshellip

                          Am I having fun now And is this what I set out to do

                          Am I having fun nowIs

                          this

                          what

                          I se

                          t out

                          to

                          do

                          bullYesbullYes

                          bullNobullYes

                          bullYesbullNo

                          bullNobullNo

                          Am I having fun nowIs

                          this

                          what

                          I se

                          t out

                          to

                          do

                          bullFunbullOn-task

                          bullNot funbullOn-task

                          bullFunbullNot on-task

                          bullNot funbullNot on-task

                          Key Features of Video Games

                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                          inappropriate behavior ndash never reverse this

                          Key Features of Video Games

                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                          focus groups to determine what really ldquograbs lsquoemrdquo

                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                          Volkow et al 2004

                          Increase salience

                          Increase salience

                          Quarterly QI review

                          The post-mortem

                          Your 1 Organizational Tool

                          Your 1 Organizational Tool

                          Yoga read

                          Staff meeting

                          Planningsession

                          Phone calls

                          billing

                          Your 1 Organizational Tool

                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                          Your 1 Organizational Tool

                          Learn French

                          Stop smoking

                          Be a better spouse

                          The ldquoBig Fiverdquo

                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                          The ldquoBig Fiverdquo

                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                          The ldquoBig Fiverdquo

                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                          The ldquoBig Fiverdquo

                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                          The ldquoBig Fiverdquo

                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                          A CHALLENGEhellip

                          wwwDrNowellcom

                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                          DavidNowellSeminars

                          DavidNowell

                          • Slide 1
                          • hellipa challenge
                          • Slide 3
                          • Perspective of this workshophellip
                          • ldquoTop ndash downrdquo dysfunction
                          • ldquoBottom - uprdquo dysfunction
                          • Slide 7
                          • Whatrsquos the kidrsquos deal
                          • Overview
                          • This Dense Pudding
                          • Sensory Processing Disorder
                          • Slide 12
                          • Slide 13
                          • Developmental considerations
                          • Sensory ProcessingIntegration Disorder and DSM-V
                          • Whatrsquos the kidrsquos deal (2)
                          • Slide 17
                          • Whatrsquos the kidrsquos deal (3)
                          • Slide 19
                          • Strategies
                          • Regulatory-Sensory Processing Disorders
                          • Slide 22
                          • Slide 23
                          • Regulatory-Sensory Processing Disorders (2)
                          • Slide 25
                          • Central Auditory Processing Disorder
                          • Slide 27
                          • Slide 28
                          • Slide 29
                          • Central Auditory Processing Disorder (2)
                          • Central Auditory Processing Disorder (3)
                          • Central Auditory Processing Disorder (4)
                          • CAPD or ADHD
                          • Whatrsquos the kidrsquos deal (4)
                          • Slide 35
                          • Strategies (2)
                          • (C)APD
                          • Treatment for CAPD
                          • Treatment for CAPD (2)
                          • Self-assessment
                          • Attention Deficit Hyperactivity Disorder
                          • Slide 42
                          • Attention Deficit Hyperactivity Disorder (2)
                          • (85 ndash X) x 365
                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                          • Core symptoms
                          • Core symptoms (2)
                          • hellipand the rest of the criteria
                          • Slide 49
                          • Functional impact of core symptoms
                          • Functional impact of core symptoms (2)
                          • Functional impact of core symptoms (3)
                          • Slide 53
                          • Functional impact of core symptoms (4)
                          • Functional impact of core symptoms (5)
                          • Functional impact of core symptoms (6)
                          • Functional impact of core symptoms (7)
                          • Functional impact of core symptoms (8)
                          • Functional impact of core symptoms (9)
                          • Subtypes of ADHD
                          • Subtypes of ADHD (2)
                          • Common comorbidities with ADHD
                          • Slide 63
                          • Common comorbidities with ADHD (2)
                          • ADHD and girls
                          • Slide 66
                          • Slide 67
                          • ADHD and women
                          • Slide 69
                          • ADHD and women (2)
                          • Executive Functioning An Overarching Theme
                          • The Executive Functions
                          • The Executive Functions (2)
                          • Slide 74
                          • Slide 75
                          • Appropriate expectations
                          • Age-appropriate expectations
                          • Age-appropriate expectations (2)
                          • Age-appropriate expectations (3)
                          • Age-appropriate expectations (4)
                          • Age-appropriate expectations (5)
                          • ldquowhat isrdquo vs ldquowhat could berdquo
                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                          • Slide 84
                          • Slide 85
                          • Strategies (3)
                          • Pharmacotherapy
                          • Behavioral Supports
                          • Slide 89
                          • Slide 90
                          • Slide 91
                          • Slide 92
                          • Slide 93
                          • Slide 94
                          • Slide 95
                          • Slide 96
                          • Slide 97
                          • Slide 98
                          • Slide 99
                          • Slide 100
                          • Slide 101
                          • Slide 102
                          • Slide 103
                          • Slide 104
                          • Slide 105
                          • Slide 106
                          • Slide 107
                          • Slide 108
                          • Slide 109
                          • Slide 110
                          • Time Out
                          • Token economy
                          • Slide 113
                          • Slide 114
                          • Slide 115
                          • Intrinsic motivation
                          • Slide 117
                          • Slide 118
                          • Slide 119
                          • Metacognition
                          • ldquoLend Me Your Brainrdquo
                          • What Does Dopamine Feel Like
                          • Preferred States What Does Dopamine Feel Like
                          • Slide 124
                          • PREFERRED STATES INVENTORY
                          • PREFERRED STATES INVENTORY (2)
                          • PREFERRED STATES INVENTORY (3)
                          • Slide 128
                          • Slide 129
                          • Broaden and Build
                          • ldquoNeuroMalleabilityrdquo
                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                          • The reward-and-planning system
                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                          • The reward-and-planning system (2)
                          • Ways the reward-and-planning system can go wrong
                          • Ways the reward-and-planning system can go wrong (2)
                          • Ways the reward-and-planning system can go wrong (3)
                          • Ways the reward-and-planning system can go wrong (4)
                          • Slide 141
                          • Lend Me Your Brain
                          • Ways the reward-and-planning system can go wrong (5)
                          • Ways the reward-and-planning system can go wrong (6)
                          • Ways the reward-and-planning system can go wrong (7)
                          • Slide 146
                          • Ways the reward-and-planning system can go wrong (8)
                          • Ways the reward-and-planning system can go wrong (9)
                          • Slide 149
                          • Ways the reward-and-planning system can go wrong (10)
                          • Ways the reward-and-planning system can go wrong (11)
                          • Slide 152
                          • Ways the reward-and-planning system can go wrong (12)
                          • Slide 154
                          • Ways the reward-and-planning system can go wrong (13)
                          • Ways the reward-and-planning system can go wrong (14)
                          • Slide 157
                          • Slide 158
                          • Slide 159
                          • Ways the reward-and-planning system can go wrong (15)
                          • Ways the reward-and-planning system can go wrong (16)
                          • Slide 162
                          • Ways the reward-and-planning system can go wrong (17)
                          • Slide 164
                          • Instant gratification vs executive gratification
                          • Slide 166
                          • Slide 167
                          • Slide 168
                          • Slide 169
                          • Slide 170
                          • Self-Talk Proficiency
                          • Self-Talk Proficiency (2)
                          • Self-Talk Proficiency (3)
                          • Self-Talk Proficiency (4)
                          • Match the Picture
                          • Slide 176
                          • Slide 177
                          • Distraction Delay Training
                          • Slide 179
                          • Slide 180
                          • Executive Estimates Training
                          • Learning Time
                          • Learning Time (2)
                          • Learning Time (3)
                          • Slide 185
                          • Slide 186
                          • Learning Time (4)
                          • Asking two questionshellip
                          • Slide 189
                          • Slide 190
                          • Key Features of Video Games
                          • Key Features of Video Games (2)
                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                          • Slide 194
                          • Slide 195
                          • Slide 196
                          • Slide 197
                          • Slide 198
                          • Slide 199
                          • Slide 200
                          • Slide 201
                          • Quarterly QI review
                          • The post-mortem
                          • Slide 204
                          • Slide 205
                          • Slide 206
                          • Slide 207
                          • Slide 208
                          • Slide 209
                          • Slide 210
                          • The ldquoBig Fiverdquo
                          • Slide 212
                          • Slide 213
                          • The ldquoBig Fiverdquo (2)
                          • Slide 215
                          • Slide 216
                          • Slide 217
                          • The ldquoBig Fiverdquo (3)
                          • The ldquoBig Fiverdquo (4)
                          • The ldquoBig Fiverdquo (5)
                          • A challengehellip
                          • Slide 222

                            Whatrsquos the kidrsquos deal

                            Strategies

                            Regulatory-Sensory Processing Disorders

                            Treatment ldquotop downrdquo

                            ldquobottom uprdquo

                            Regulatory-Sensory Processing Disorders

                            Treatment ldquotop downrdquo ldquobottom uprdquo

                            Central Auditory Processing Disorder

                            bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                            Central Auditory Processing Disorder

                            Central Auditory Processing Disorder

                            CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                            Central Auditory Processing Disorder

                            - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                            Central Auditory Processing Disorder

                            - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                            CAPD or ADHD

                            Whatrsquos the kidrsquos deal

                            Strategies

                            (C)APD

                            Treatment ldquotop downrdquo ldquobottom uprdquo

                            X

                            Treatment for CAPD

                            Environmental modifications

                            Treatment for CAPD

                            Compensatory Strategies

                            Self-assessment

                            >

                            Attention Deficit Hyperactivity Disorder

                            Increase salience

                            Attention Deficit Hyperactivity Disorder

                            (85 ndash X) x 365

                            ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                            Core symptoms

                            Inattention distractibility

                            Core symptoms

                            Hyperactivity impulsivity

                            hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                            mental disorder

                            Functional impact of core symptoms

                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                            Functional impact of core symptoms

                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                            Functional impact of core symptoms

                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                            Functional impact of core symptoms

                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                            Functional impact of core symptoms

                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                            Functional impact of core symptoms

                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                            Functional impact of core symptoms

                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                            Functional impact of core symptoms

                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                            Functional impact of core symptoms

                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                            Subtypes of ADHD

                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                            Subtypes of ADHD

                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                            Specifed

                            Common comorbidities with ADHD

                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                            processing challenges

                            Common comorbidities with ADHD

                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                            processing challenges

                            ADHD and girls

                            ADHD and women

                            ADHD and women

                            More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                            partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                            disorganization

                            Executive FunctioningAn Overarching Theme

                            Sensory Processing Disorder Central Auditory Processing

                            Disorder ADHD and Executive Dysfunction

                            The Executive Functions

                            Internalizing speech Previewing

                            Prioritizing Tempo control Inhibition

                            The Executive Functions

                            Determining salience (whatrsquos in it for me)

                            Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                            Appropriate expectations

                            Age-appropriate expectations

                            Preschool 1-step errands Chores with cues Basic inhibition

                            Age-appropriate expectations

                            K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                            3rd ndash 5th

                            Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                            Age-appropriate expectations

                            6th ndash 8th

                            complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                            Age-appropriate expectations

                            Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                            already made Take othersrsquo perspective

                            Age-appropriate expectations

                            ldquowhat isrdquo vs ldquowhat could berdquo

                            ldquowhat isrdquo vs ldquowhat could berdquo

                            Inter-connectedness of systems Cortico-striatal system for example

                            Strategies

                            Pharmacotherapy

                            X

                            Behavioral Supports

                            A B C

                            A B C

                            behavior

                            A B C

                            consequences

                            A B C

                            antecedent

                            A B C

                            A B C

                            antecedent

                            A B C

                            antecedent

                            easy hard

                            A B C

                            consequences

                            R P

                            +

                            -

                            R+ P+

                            R- P-

                            Time Out

                            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                            Token economy

                            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                            Intrinsic motivation

                            A B C

                            consequencesX

                            A B C

                            behavior

                            Metacognition

                            Metacognitive knowledge Metacognitive strategies

                            ldquoLend Me Your Brainrdquo

                            What Does Dopamine Feel Like

                            The Physiology of Motivation and Reward

                            Preferred States What Does Dopamine Feel Like

                            1 Great experience2 Kodak moment3 The feeeeling

                            David D Nowell PhD189 May Street

                            Worcester Mass 01602DrNowellcom

                            PREFERRED STATES INVENTORY

                            wwwLulucom

                            Identify 20 peak experiences For each peak experience identify the

                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                            of that moment Name it Check the 20 peak moment-feelings for

                            clusters groupings There will probably be 4 or 5

                            PREFERRED STATES INVENTORY

                            Find a word a label for each of the groupings

                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                            ldquovaluesrdquo ways that you really like to feel

                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                            PREFERRED STATES INVENTORY

                            PREFERRED STATES INVENTORY

                            Broaden and Build

                            ldquoNeuroMalleabilityrdquo

                            Why You Arenrsquot Getting Exactly What You Want All the Time

                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                            The reward-and-planning system

                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                            ldquowhat isrdquo vs ldquowhat could berdquo

                            ldquowhat isrdquo vs ldquowhat could berdquo

                            The reward-and-planning system

                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                            Ways the reward-and-planning system can go wrong

                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                            Ways the reward-and-planning system can go wrong

                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                            Ways the reward-and-planning system can go wrong

                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                            Ways the reward-and-planning system can go wrong

                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                            Lend Me Your Brain

                            Supporting Clients with Executive Dysfunction

                            Ways the reward-and-planning system can go wrong

                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                            Ways the reward-and-planning system can go wrong

                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                            Ways the reward-and-planning system can go wrong

                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                            Ways the reward-and-planning system can go wrong

                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                            Too busy with current activity

                            Field dependent

                            Ways the reward-and-planning system can go wrong

                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                            Ways the reward-and-planning system can go wrong

                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                            Ways the reward-and-planning system can go wrong

                            Sequence problem-solve

                            Ways the reward-and-planning system can go wrong

                            Sequence problem-solve Verbal working memory Nonverbal working memory

                            Ways the reward-and-planning system can go wrong

                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                            Ways the reward-and-planning system can go wrong

                            Block out distractions

                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                            - E Goldberg

                            Ways the reward-and-planning system can go wrong

                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                            Ways the reward-and-planning system can go wrong

                            Get the reward

                            Ways the reward-and-planning system can go wrong

                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                            Instant gratification vs

                            executive gratification

                            A B C

                            behaviorx

                            Self-Talk Proficiency

                            Self-Talk Proficiency

                            bull -ldquoHow are you going to know when to be readyrdquo

                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                            takerdquordquo

                            Self-Talk Proficiency

                            bull -ldquoHow are you going to know what you needrdquo

                            bull -ldquoHow are you going to know what is most importantrdquo

                            bull -ldquoHow are you going to decide what to do firstrdquo

                            bull -ldquoHow will you know when you are donerdquo

                            Self-Talk Proficiency

                            bull -ldquoHow will you continue when you are tiredrdquo

                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                            differentlyrdquo ldquoWho will be the first person to notice

                            thathelliprdquo

                            Match the Picture

                            Distraction Delay Training

                            Executive Estimates Training

                            X

                            Learning Time

                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                            Learning Time

                            Learning Time

                            Learning Time

                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                            Asking two questionshellip

                            Am I having fun now And is this what I set out to do

                            Am I having fun nowIs

                            this

                            what

                            I se

                            t out

                            to

                            do

                            bullYesbullYes

                            bullNobullYes

                            bullYesbullNo

                            bullNobullNo

                            Am I having fun nowIs

                            this

                            what

                            I se

                            t out

                            to

                            do

                            bullFunbullOn-task

                            bullNot funbullOn-task

                            bullFunbullNot on-task

                            bullNot funbullNot on-task

                            Key Features of Video Games

                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                            inappropriate behavior ndash never reverse this

                            Key Features of Video Games

                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                            focus groups to determine what really ldquograbs lsquoemrdquo

                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                            Volkow et al 2004

                            Increase salience

                            Increase salience

                            Quarterly QI review

                            The post-mortem

                            Your 1 Organizational Tool

                            Your 1 Organizational Tool

                            Yoga read

                            Staff meeting

                            Planningsession

                            Phone calls

                            billing

                            Your 1 Organizational Tool

                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                            Your 1 Organizational Tool

                            Learn French

                            Stop smoking

                            Be a better spouse

                            The ldquoBig Fiverdquo

                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                            The ldquoBig Fiverdquo

                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                            The ldquoBig Fiverdquo

                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                            The ldquoBig Fiverdquo

                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                            The ldquoBig Fiverdquo

                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                            A CHALLENGEhellip

                            wwwDrNowellcom

                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                            DavidNowellSeminars

                            DavidNowell

                            • Slide 1
                            • hellipa challenge
                            • Slide 3
                            • Perspective of this workshophellip
                            • ldquoTop ndash downrdquo dysfunction
                            • ldquoBottom - uprdquo dysfunction
                            • Slide 7
                            • Whatrsquos the kidrsquos deal
                            • Overview
                            • This Dense Pudding
                            • Sensory Processing Disorder
                            • Slide 12
                            • Slide 13
                            • Developmental considerations
                            • Sensory ProcessingIntegration Disorder and DSM-V
                            • Whatrsquos the kidrsquos deal (2)
                            • Slide 17
                            • Whatrsquos the kidrsquos deal (3)
                            • Slide 19
                            • Strategies
                            • Regulatory-Sensory Processing Disorders
                            • Slide 22
                            • Slide 23
                            • Regulatory-Sensory Processing Disorders (2)
                            • Slide 25
                            • Central Auditory Processing Disorder
                            • Slide 27
                            • Slide 28
                            • Slide 29
                            • Central Auditory Processing Disorder (2)
                            • Central Auditory Processing Disorder (3)
                            • Central Auditory Processing Disorder (4)
                            • CAPD or ADHD
                            • Whatrsquos the kidrsquos deal (4)
                            • Slide 35
                            • Strategies (2)
                            • (C)APD
                            • Treatment for CAPD
                            • Treatment for CAPD (2)
                            • Self-assessment
                            • Attention Deficit Hyperactivity Disorder
                            • Slide 42
                            • Attention Deficit Hyperactivity Disorder (2)
                            • (85 ndash X) x 365
                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                            • Core symptoms
                            • Core symptoms (2)
                            • hellipand the rest of the criteria
                            • Slide 49
                            • Functional impact of core symptoms
                            • Functional impact of core symptoms (2)
                            • Functional impact of core symptoms (3)
                            • Slide 53
                            • Functional impact of core symptoms (4)
                            • Functional impact of core symptoms (5)
                            • Functional impact of core symptoms (6)
                            • Functional impact of core symptoms (7)
                            • Functional impact of core symptoms (8)
                            • Functional impact of core symptoms (9)
                            • Subtypes of ADHD
                            • Subtypes of ADHD (2)
                            • Common comorbidities with ADHD
                            • Slide 63
                            • Common comorbidities with ADHD (2)
                            • ADHD and girls
                            • Slide 66
                            • Slide 67
                            • ADHD and women
                            • Slide 69
                            • ADHD and women (2)
                            • Executive Functioning An Overarching Theme
                            • The Executive Functions
                            • The Executive Functions (2)
                            • Slide 74
                            • Slide 75
                            • Appropriate expectations
                            • Age-appropriate expectations
                            • Age-appropriate expectations (2)
                            • Age-appropriate expectations (3)
                            • Age-appropriate expectations (4)
                            • Age-appropriate expectations (5)
                            • ldquowhat isrdquo vs ldquowhat could berdquo
                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                            • Slide 84
                            • Slide 85
                            • Strategies (3)
                            • Pharmacotherapy
                            • Behavioral Supports
                            • Slide 89
                            • Slide 90
                            • Slide 91
                            • Slide 92
                            • Slide 93
                            • Slide 94
                            • Slide 95
                            • Slide 96
                            • Slide 97
                            • Slide 98
                            • Slide 99
                            • Slide 100
                            • Slide 101
                            • Slide 102
                            • Slide 103
                            • Slide 104
                            • Slide 105
                            • Slide 106
                            • Slide 107
                            • Slide 108
                            • Slide 109
                            • Slide 110
                            • Time Out
                            • Token economy
                            • Slide 113
                            • Slide 114
                            • Slide 115
                            • Intrinsic motivation
                            • Slide 117
                            • Slide 118
                            • Slide 119
                            • Metacognition
                            • ldquoLend Me Your Brainrdquo
                            • What Does Dopamine Feel Like
                            • Preferred States What Does Dopamine Feel Like
                            • Slide 124
                            • PREFERRED STATES INVENTORY
                            • PREFERRED STATES INVENTORY (2)
                            • PREFERRED STATES INVENTORY (3)
                            • Slide 128
                            • Slide 129
                            • Broaden and Build
                            • ldquoNeuroMalleabilityrdquo
                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                            • The reward-and-planning system
                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                            • The reward-and-planning system (2)
                            • Ways the reward-and-planning system can go wrong
                            • Ways the reward-and-planning system can go wrong (2)
                            • Ways the reward-and-planning system can go wrong (3)
                            • Ways the reward-and-planning system can go wrong (4)
                            • Slide 141
                            • Lend Me Your Brain
                            • Ways the reward-and-planning system can go wrong (5)
                            • Ways the reward-and-planning system can go wrong (6)
                            • Ways the reward-and-planning system can go wrong (7)
                            • Slide 146
                            • Ways the reward-and-planning system can go wrong (8)
                            • Ways the reward-and-planning system can go wrong (9)
                            • Slide 149
                            • Ways the reward-and-planning system can go wrong (10)
                            • Ways the reward-and-planning system can go wrong (11)
                            • Slide 152
                            • Ways the reward-and-planning system can go wrong (12)
                            • Slide 154
                            • Ways the reward-and-planning system can go wrong (13)
                            • Ways the reward-and-planning system can go wrong (14)
                            • Slide 157
                            • Slide 158
                            • Slide 159
                            • Ways the reward-and-planning system can go wrong (15)
                            • Ways the reward-and-planning system can go wrong (16)
                            • Slide 162
                            • Ways the reward-and-planning system can go wrong (17)
                            • Slide 164
                            • Instant gratification vs executive gratification
                            • Slide 166
                            • Slide 167
                            • Slide 168
                            • Slide 169
                            • Slide 170
                            • Self-Talk Proficiency
                            • Self-Talk Proficiency (2)
                            • Self-Talk Proficiency (3)
                            • Self-Talk Proficiency (4)
                            • Match the Picture
                            • Slide 176
                            • Slide 177
                            • Distraction Delay Training
                            • Slide 179
                            • Slide 180
                            • Executive Estimates Training
                            • Learning Time
                            • Learning Time (2)
                            • Learning Time (3)
                            • Slide 185
                            • Slide 186
                            • Learning Time (4)
                            • Asking two questionshellip
                            • Slide 189
                            • Slide 190
                            • Key Features of Video Games
                            • Key Features of Video Games (2)
                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                            • Slide 194
                            • Slide 195
                            • Slide 196
                            • Slide 197
                            • Slide 198
                            • Slide 199
                            • Slide 200
                            • Slide 201
                            • Quarterly QI review
                            • The post-mortem
                            • Slide 204
                            • Slide 205
                            • Slide 206
                            • Slide 207
                            • Slide 208
                            • Slide 209
                            • Slide 210
                            • The ldquoBig Fiverdquo
                            • Slide 212
                            • Slide 213
                            • The ldquoBig Fiverdquo (2)
                            • Slide 215
                            • Slide 216
                            • Slide 217
                            • The ldquoBig Fiverdquo (3)
                            • The ldquoBig Fiverdquo (4)
                            • The ldquoBig Fiverdquo (5)
                            • A challengehellip
                            • Slide 222

                              Strategies

                              Regulatory-Sensory Processing Disorders

                              Treatment ldquotop downrdquo

                              ldquobottom uprdquo

                              Regulatory-Sensory Processing Disorders

                              Treatment ldquotop downrdquo ldquobottom uprdquo

                              Central Auditory Processing Disorder

                              bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                              Central Auditory Processing Disorder

                              Central Auditory Processing Disorder

                              CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                              Central Auditory Processing Disorder

                              - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                              Central Auditory Processing Disorder

                              - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                              CAPD or ADHD

                              Whatrsquos the kidrsquos deal

                              Strategies

                              (C)APD

                              Treatment ldquotop downrdquo ldquobottom uprdquo

                              X

                              Treatment for CAPD

                              Environmental modifications

                              Treatment for CAPD

                              Compensatory Strategies

                              Self-assessment

                              >

                              Attention Deficit Hyperactivity Disorder

                              Increase salience

                              Attention Deficit Hyperactivity Disorder

                              (85 ndash X) x 365

                              ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                              Core symptoms

                              Inattention distractibility

                              Core symptoms

                              Hyperactivity impulsivity

                              hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                              mental disorder

                              Functional impact of core symptoms

                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                              Functional impact of core symptoms

                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                              Functional impact of core symptoms

                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                              Functional impact of core symptoms

                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                              Functional impact of core symptoms

                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                              Functional impact of core symptoms

                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                              Functional impact of core symptoms

                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                              Functional impact of core symptoms

                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                              Functional impact of core symptoms

                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                              Subtypes of ADHD

                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                              Subtypes of ADHD

                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                              Specifed

                              Common comorbidities with ADHD

                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                              processing challenges

                              Common comorbidities with ADHD

                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                              processing challenges

                              ADHD and girls

                              ADHD and women

                              ADHD and women

                              More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                              partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                              disorganization

                              Executive FunctioningAn Overarching Theme

                              Sensory Processing Disorder Central Auditory Processing

                              Disorder ADHD and Executive Dysfunction

                              The Executive Functions

                              Internalizing speech Previewing

                              Prioritizing Tempo control Inhibition

                              The Executive Functions

                              Determining salience (whatrsquos in it for me)

                              Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                              Appropriate expectations

                              Age-appropriate expectations

                              Preschool 1-step errands Chores with cues Basic inhibition

                              Age-appropriate expectations

                              K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                              3rd ndash 5th

                              Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                              Age-appropriate expectations

                              6th ndash 8th

                              complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                              Age-appropriate expectations

                              Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                              already made Take othersrsquo perspective

                              Age-appropriate expectations

                              ldquowhat isrdquo vs ldquowhat could berdquo

                              ldquowhat isrdquo vs ldquowhat could berdquo

                              Inter-connectedness of systems Cortico-striatal system for example

                              Strategies

                              Pharmacotherapy

                              X

                              Behavioral Supports

                              A B C

                              A B C

                              behavior

                              A B C

                              consequences

                              A B C

                              antecedent

                              A B C

                              A B C

                              antecedent

                              A B C

                              antecedent

                              easy hard

                              A B C

                              consequences

                              R P

                              +

                              -

                              R+ P+

                              R- P-

                              Time Out

                              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                              Token economy

                              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                              Intrinsic motivation

                              A B C

                              consequencesX

                              A B C

                              behavior

                              Metacognition

                              Metacognitive knowledge Metacognitive strategies

                              ldquoLend Me Your Brainrdquo

                              What Does Dopamine Feel Like

                              The Physiology of Motivation and Reward

                              Preferred States What Does Dopamine Feel Like

                              1 Great experience2 Kodak moment3 The feeeeling

                              David D Nowell PhD189 May Street

                              Worcester Mass 01602DrNowellcom

                              PREFERRED STATES INVENTORY

                              wwwLulucom

                              Identify 20 peak experiences For each peak experience identify the

                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                              of that moment Name it Check the 20 peak moment-feelings for

                              clusters groupings There will probably be 4 or 5

                              PREFERRED STATES INVENTORY

                              Find a word a label for each of the groupings

                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                              ldquovaluesrdquo ways that you really like to feel

                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                              PREFERRED STATES INVENTORY

                              PREFERRED STATES INVENTORY

                              Broaden and Build

                              ldquoNeuroMalleabilityrdquo

                              Why You Arenrsquot Getting Exactly What You Want All the Time

                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                              The reward-and-planning system

                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                              ldquowhat isrdquo vs ldquowhat could berdquo

                              ldquowhat isrdquo vs ldquowhat could berdquo

                              The reward-and-planning system

                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                              Ways the reward-and-planning system can go wrong

                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                              Ways the reward-and-planning system can go wrong

                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                              Ways the reward-and-planning system can go wrong

                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                              Ways the reward-and-planning system can go wrong

                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                              Lend Me Your Brain

                              Supporting Clients with Executive Dysfunction

                              Ways the reward-and-planning system can go wrong

                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                              Ways the reward-and-planning system can go wrong

                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                              Ways the reward-and-planning system can go wrong

                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                              Ways the reward-and-planning system can go wrong

                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                              Too busy with current activity

                              Field dependent

                              Ways the reward-and-planning system can go wrong

                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                              Ways the reward-and-planning system can go wrong

                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                              Ways the reward-and-planning system can go wrong

                              Sequence problem-solve

                              Ways the reward-and-planning system can go wrong

                              Sequence problem-solve Verbal working memory Nonverbal working memory

                              Ways the reward-and-planning system can go wrong

                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                              Ways the reward-and-planning system can go wrong

                              Block out distractions

                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                              - E Goldberg

                              Ways the reward-and-planning system can go wrong

                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                              Ways the reward-and-planning system can go wrong

                              Get the reward

                              Ways the reward-and-planning system can go wrong

                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                              Instant gratification vs

                              executive gratification

                              A B C

                              behaviorx

                              Self-Talk Proficiency

                              Self-Talk Proficiency

                              bull -ldquoHow are you going to know when to be readyrdquo

                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                              takerdquordquo

                              Self-Talk Proficiency

                              bull -ldquoHow are you going to know what you needrdquo

                              bull -ldquoHow are you going to know what is most importantrdquo

                              bull -ldquoHow are you going to decide what to do firstrdquo

                              bull -ldquoHow will you know when you are donerdquo

                              Self-Talk Proficiency

                              bull -ldquoHow will you continue when you are tiredrdquo

                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                              differentlyrdquo ldquoWho will be the first person to notice

                              thathelliprdquo

                              Match the Picture

                              Distraction Delay Training

                              Executive Estimates Training

                              X

                              Learning Time

                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                              Learning Time

                              Learning Time

                              Learning Time

                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                              Asking two questionshellip

                              Am I having fun now And is this what I set out to do

                              Am I having fun nowIs

                              this

                              what

                              I se

                              t out

                              to

                              do

                              bullYesbullYes

                              bullNobullYes

                              bullYesbullNo

                              bullNobullNo

                              Am I having fun nowIs

                              this

                              what

                              I se

                              t out

                              to

                              do

                              bullFunbullOn-task

                              bullNot funbullOn-task

                              bullFunbullNot on-task

                              bullNot funbullNot on-task

                              Key Features of Video Games

                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                              inappropriate behavior ndash never reverse this

                              Key Features of Video Games

                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                              focus groups to determine what really ldquograbs lsquoemrdquo

                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                              Volkow et al 2004

                              Increase salience

                              Increase salience

                              Quarterly QI review

                              The post-mortem

                              Your 1 Organizational Tool

                              Your 1 Organizational Tool

                              Yoga read

                              Staff meeting

                              Planningsession

                              Phone calls

                              billing

                              Your 1 Organizational Tool

                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                              Your 1 Organizational Tool

                              Learn French

                              Stop smoking

                              Be a better spouse

                              The ldquoBig Fiverdquo

                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                              The ldquoBig Fiverdquo

                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                              The ldquoBig Fiverdquo

                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                              The ldquoBig Fiverdquo

                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                              The ldquoBig Fiverdquo

                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                              A CHALLENGEhellip

                              wwwDrNowellcom

                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                              DavidNowellSeminars

                              DavidNowell

                              • Slide 1
                              • hellipa challenge
                              • Slide 3
                              • Perspective of this workshophellip
                              • ldquoTop ndash downrdquo dysfunction
                              • ldquoBottom - uprdquo dysfunction
                              • Slide 7
                              • Whatrsquos the kidrsquos deal
                              • Overview
                              • This Dense Pudding
                              • Sensory Processing Disorder
                              • Slide 12
                              • Slide 13
                              • Developmental considerations
                              • Sensory ProcessingIntegration Disorder and DSM-V
                              • Whatrsquos the kidrsquos deal (2)
                              • Slide 17
                              • Whatrsquos the kidrsquos deal (3)
                              • Slide 19
                              • Strategies
                              • Regulatory-Sensory Processing Disorders
                              • Slide 22
                              • Slide 23
                              • Regulatory-Sensory Processing Disorders (2)
                              • Slide 25
                              • Central Auditory Processing Disorder
                              • Slide 27
                              • Slide 28
                              • Slide 29
                              • Central Auditory Processing Disorder (2)
                              • Central Auditory Processing Disorder (3)
                              • Central Auditory Processing Disorder (4)
                              • CAPD or ADHD
                              • Whatrsquos the kidrsquos deal (4)
                              • Slide 35
                              • Strategies (2)
                              • (C)APD
                              • Treatment for CAPD
                              • Treatment for CAPD (2)
                              • Self-assessment
                              • Attention Deficit Hyperactivity Disorder
                              • Slide 42
                              • Attention Deficit Hyperactivity Disorder (2)
                              • (85 ndash X) x 365
                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                              • Core symptoms
                              • Core symptoms (2)
                              • hellipand the rest of the criteria
                              • Slide 49
                              • Functional impact of core symptoms
                              • Functional impact of core symptoms (2)
                              • Functional impact of core symptoms (3)
                              • Slide 53
                              • Functional impact of core symptoms (4)
                              • Functional impact of core symptoms (5)
                              • Functional impact of core symptoms (6)
                              • Functional impact of core symptoms (7)
                              • Functional impact of core symptoms (8)
                              • Functional impact of core symptoms (9)
                              • Subtypes of ADHD
                              • Subtypes of ADHD (2)
                              • Common comorbidities with ADHD
                              • Slide 63
                              • Common comorbidities with ADHD (2)
                              • ADHD and girls
                              • Slide 66
                              • Slide 67
                              • ADHD and women
                              • Slide 69
                              • ADHD and women (2)
                              • Executive Functioning An Overarching Theme
                              • The Executive Functions
                              • The Executive Functions (2)
                              • Slide 74
                              • Slide 75
                              • Appropriate expectations
                              • Age-appropriate expectations
                              • Age-appropriate expectations (2)
                              • Age-appropriate expectations (3)
                              • Age-appropriate expectations (4)
                              • Age-appropriate expectations (5)
                              • ldquowhat isrdquo vs ldquowhat could berdquo
                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                              • Slide 84
                              • Slide 85
                              • Strategies (3)
                              • Pharmacotherapy
                              • Behavioral Supports
                              • Slide 89
                              • Slide 90
                              • Slide 91
                              • Slide 92
                              • Slide 93
                              • Slide 94
                              • Slide 95
                              • Slide 96
                              • Slide 97
                              • Slide 98
                              • Slide 99
                              • Slide 100
                              • Slide 101
                              • Slide 102
                              • Slide 103
                              • Slide 104
                              • Slide 105
                              • Slide 106
                              • Slide 107
                              • Slide 108
                              • Slide 109
                              • Slide 110
                              • Time Out
                              • Token economy
                              • Slide 113
                              • Slide 114
                              • Slide 115
                              • Intrinsic motivation
                              • Slide 117
                              • Slide 118
                              • Slide 119
                              • Metacognition
                              • ldquoLend Me Your Brainrdquo
                              • What Does Dopamine Feel Like
                              • Preferred States What Does Dopamine Feel Like
                              • Slide 124
                              • PREFERRED STATES INVENTORY
                              • PREFERRED STATES INVENTORY (2)
                              • PREFERRED STATES INVENTORY (3)
                              • Slide 128
                              • Slide 129
                              • Broaden and Build
                              • ldquoNeuroMalleabilityrdquo
                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                              • The reward-and-planning system
                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                              • The reward-and-planning system (2)
                              • Ways the reward-and-planning system can go wrong
                              • Ways the reward-and-planning system can go wrong (2)
                              • Ways the reward-and-planning system can go wrong (3)
                              • Ways the reward-and-planning system can go wrong (4)
                              • Slide 141
                              • Lend Me Your Brain
                              • Ways the reward-and-planning system can go wrong (5)
                              • Ways the reward-and-planning system can go wrong (6)
                              • Ways the reward-and-planning system can go wrong (7)
                              • Slide 146
                              • Ways the reward-and-planning system can go wrong (8)
                              • Ways the reward-and-planning system can go wrong (9)
                              • Slide 149
                              • Ways the reward-and-planning system can go wrong (10)
                              • Ways the reward-and-planning system can go wrong (11)
                              • Slide 152
                              • Ways the reward-and-planning system can go wrong (12)
                              • Slide 154
                              • Ways the reward-and-planning system can go wrong (13)
                              • Ways the reward-and-planning system can go wrong (14)
                              • Slide 157
                              • Slide 158
                              • Slide 159
                              • Ways the reward-and-planning system can go wrong (15)
                              • Ways the reward-and-planning system can go wrong (16)
                              • Slide 162
                              • Ways the reward-and-planning system can go wrong (17)
                              • Slide 164
                              • Instant gratification vs executive gratification
                              • Slide 166
                              • Slide 167
                              • Slide 168
                              • Slide 169
                              • Slide 170
                              • Self-Talk Proficiency
                              • Self-Talk Proficiency (2)
                              • Self-Talk Proficiency (3)
                              • Self-Talk Proficiency (4)
                              • Match the Picture
                              • Slide 176
                              • Slide 177
                              • Distraction Delay Training
                              • Slide 179
                              • Slide 180
                              • Executive Estimates Training
                              • Learning Time
                              • Learning Time (2)
                              • Learning Time (3)
                              • Slide 185
                              • Slide 186
                              • Learning Time (4)
                              • Asking two questionshellip
                              • Slide 189
                              • Slide 190
                              • Key Features of Video Games
                              • Key Features of Video Games (2)
                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                              • Slide 194
                              • Slide 195
                              • Slide 196
                              • Slide 197
                              • Slide 198
                              • Slide 199
                              • Slide 200
                              • Slide 201
                              • Quarterly QI review
                              • The post-mortem
                              • Slide 204
                              • Slide 205
                              • Slide 206
                              • Slide 207
                              • Slide 208
                              • Slide 209
                              • Slide 210
                              • The ldquoBig Fiverdquo
                              • Slide 212
                              • Slide 213
                              • The ldquoBig Fiverdquo (2)
                              • Slide 215
                              • Slide 216
                              • Slide 217
                              • The ldquoBig Fiverdquo (3)
                              • The ldquoBig Fiverdquo (4)
                              • The ldquoBig Fiverdquo (5)
                              • A challengehellip
                              • Slide 222

                                Regulatory-Sensory Processing Disorders

                                Treatment ldquotop downrdquo

                                ldquobottom uprdquo

                                Regulatory-Sensory Processing Disorders

                                Treatment ldquotop downrdquo ldquobottom uprdquo

                                Central Auditory Processing Disorder

                                bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                                Central Auditory Processing Disorder

                                Central Auditory Processing Disorder

                                CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                                Central Auditory Processing Disorder

                                - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                                Central Auditory Processing Disorder

                                - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                                CAPD or ADHD

                                Whatrsquos the kidrsquos deal

                                Strategies

                                (C)APD

                                Treatment ldquotop downrdquo ldquobottom uprdquo

                                X

                                Treatment for CAPD

                                Environmental modifications

                                Treatment for CAPD

                                Compensatory Strategies

                                Self-assessment

                                >

                                Attention Deficit Hyperactivity Disorder

                                Increase salience

                                Attention Deficit Hyperactivity Disorder

                                (85 ndash X) x 365

                                ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                Core symptoms

                                Inattention distractibility

                                Core symptoms

                                Hyperactivity impulsivity

                                hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                mental disorder

                                Functional impact of core symptoms

                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                Functional impact of core symptoms

                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                Functional impact of core symptoms

                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                Functional impact of core symptoms

                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                Functional impact of core symptoms

                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                Functional impact of core symptoms

                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                Functional impact of core symptoms

                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                Functional impact of core symptoms

                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                Functional impact of core symptoms

                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                Subtypes of ADHD

                                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                Subtypes of ADHD

                                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                Specifed

                                Common comorbidities with ADHD

                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                processing challenges

                                Common comorbidities with ADHD

                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                processing challenges

                                ADHD and girls

                                ADHD and women

                                ADHD and women

                                More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                disorganization

                                Executive FunctioningAn Overarching Theme

                                Sensory Processing Disorder Central Auditory Processing

                                Disorder ADHD and Executive Dysfunction

                                The Executive Functions

                                Internalizing speech Previewing

                                Prioritizing Tempo control Inhibition

                                The Executive Functions

                                Determining salience (whatrsquos in it for me)

                                Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                Appropriate expectations

                                Age-appropriate expectations

                                Preschool 1-step errands Chores with cues Basic inhibition

                                Age-appropriate expectations

                                K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                3rd ndash 5th

                                Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                Age-appropriate expectations

                                6th ndash 8th

                                complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                Age-appropriate expectations

                                Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                already made Take othersrsquo perspective

                                Age-appropriate expectations

                                ldquowhat isrdquo vs ldquowhat could berdquo

                                ldquowhat isrdquo vs ldquowhat could berdquo

                                Inter-connectedness of systems Cortico-striatal system for example

                                Strategies

                                Pharmacotherapy

                                X

                                Behavioral Supports

                                A B C

                                A B C

                                behavior

                                A B C

                                consequences

                                A B C

                                antecedent

                                A B C

                                A B C

                                antecedent

                                A B C

                                antecedent

                                easy hard

                                A B C

                                consequences

                                R P

                                +

                                -

                                R+ P+

                                R- P-

                                Time Out

                                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                Token economy

                                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                Intrinsic motivation

                                A B C

                                consequencesX

                                A B C

                                behavior

                                Metacognition

                                Metacognitive knowledge Metacognitive strategies

                                ldquoLend Me Your Brainrdquo

                                What Does Dopamine Feel Like

                                The Physiology of Motivation and Reward

                                Preferred States What Does Dopamine Feel Like

                                1 Great experience2 Kodak moment3 The feeeeling

                                David D Nowell PhD189 May Street

                                Worcester Mass 01602DrNowellcom

                                PREFERRED STATES INVENTORY

                                wwwLulucom

                                Identify 20 peak experiences For each peak experience identify the

                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                of that moment Name it Check the 20 peak moment-feelings for

                                clusters groupings There will probably be 4 or 5

                                PREFERRED STATES INVENTORY

                                Find a word a label for each of the groupings

                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                ldquovaluesrdquo ways that you really like to feel

                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                PREFERRED STATES INVENTORY

                                PREFERRED STATES INVENTORY

                                Broaden and Build

                                ldquoNeuroMalleabilityrdquo

                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                The reward-and-planning system

                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                ldquowhat isrdquo vs ldquowhat could berdquo

                                ldquowhat isrdquo vs ldquowhat could berdquo

                                The reward-and-planning system

                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                Ways the reward-and-planning system can go wrong

                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                Ways the reward-and-planning system can go wrong

                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                Ways the reward-and-planning system can go wrong

                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                Ways the reward-and-planning system can go wrong

                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                Lend Me Your Brain

                                Supporting Clients with Executive Dysfunction

                                Ways the reward-and-planning system can go wrong

                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                Ways the reward-and-planning system can go wrong

                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                Ways the reward-and-planning system can go wrong

                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                Ways the reward-and-planning system can go wrong

                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                Too busy with current activity

                                Field dependent

                                Ways the reward-and-planning system can go wrong

                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                Ways the reward-and-planning system can go wrong

                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                Ways the reward-and-planning system can go wrong

                                Sequence problem-solve

                                Ways the reward-and-planning system can go wrong

                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                Ways the reward-and-planning system can go wrong

                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                Ways the reward-and-planning system can go wrong

                                Block out distractions

                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                - E Goldberg

                                Ways the reward-and-planning system can go wrong

                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                Ways the reward-and-planning system can go wrong

                                Get the reward

                                Ways the reward-and-planning system can go wrong

                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                Instant gratification vs

                                executive gratification

                                A B C

                                behaviorx

                                Self-Talk Proficiency

                                Self-Talk Proficiency

                                bull -ldquoHow are you going to know when to be readyrdquo

                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                takerdquordquo

                                Self-Talk Proficiency

                                bull -ldquoHow are you going to know what you needrdquo

                                bull -ldquoHow are you going to know what is most importantrdquo

                                bull -ldquoHow are you going to decide what to do firstrdquo

                                bull -ldquoHow will you know when you are donerdquo

                                Self-Talk Proficiency

                                bull -ldquoHow will you continue when you are tiredrdquo

                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                differentlyrdquo ldquoWho will be the first person to notice

                                thathelliprdquo

                                Match the Picture

                                Distraction Delay Training

                                Executive Estimates Training

                                X

                                Learning Time

                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                Learning Time

                                Learning Time

                                Learning Time

                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                Asking two questionshellip

                                Am I having fun now And is this what I set out to do

                                Am I having fun nowIs

                                this

                                what

                                I se

                                t out

                                to

                                do

                                bullYesbullYes

                                bullNobullYes

                                bullYesbullNo

                                bullNobullNo

                                Am I having fun nowIs

                                this

                                what

                                I se

                                t out

                                to

                                do

                                bullFunbullOn-task

                                bullNot funbullOn-task

                                bullFunbullNot on-task

                                bullNot funbullNot on-task

                                Key Features of Video Games

                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                inappropriate behavior ndash never reverse this

                                Key Features of Video Games

                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                focus groups to determine what really ldquograbs lsquoemrdquo

                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                Volkow et al 2004

                                Increase salience

                                Increase salience

                                Quarterly QI review

                                The post-mortem

                                Your 1 Organizational Tool

                                Your 1 Organizational Tool

                                Yoga read

                                Staff meeting

                                Planningsession

                                Phone calls

                                billing

                                Your 1 Organizational Tool

                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                Your 1 Organizational Tool

                                Learn French

                                Stop smoking

                                Be a better spouse

                                The ldquoBig Fiverdquo

                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                The ldquoBig Fiverdquo

                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                The ldquoBig Fiverdquo

                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                The ldquoBig Fiverdquo

                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                The ldquoBig Fiverdquo

                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                A CHALLENGEhellip

                                wwwDrNowellcom

                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                DavidNowellSeminars

                                DavidNowell

                                • Slide 1
                                • hellipa challenge
                                • Slide 3
                                • Perspective of this workshophellip
                                • ldquoTop ndash downrdquo dysfunction
                                • ldquoBottom - uprdquo dysfunction
                                • Slide 7
                                • Whatrsquos the kidrsquos deal
                                • Overview
                                • This Dense Pudding
                                • Sensory Processing Disorder
                                • Slide 12
                                • Slide 13
                                • Developmental considerations
                                • Sensory ProcessingIntegration Disorder and DSM-V
                                • Whatrsquos the kidrsquos deal (2)
                                • Slide 17
                                • Whatrsquos the kidrsquos deal (3)
                                • Slide 19
                                • Strategies
                                • Regulatory-Sensory Processing Disorders
                                • Slide 22
                                • Slide 23
                                • Regulatory-Sensory Processing Disorders (2)
                                • Slide 25
                                • Central Auditory Processing Disorder
                                • Slide 27
                                • Slide 28
                                • Slide 29
                                • Central Auditory Processing Disorder (2)
                                • Central Auditory Processing Disorder (3)
                                • Central Auditory Processing Disorder (4)
                                • CAPD or ADHD
                                • Whatrsquos the kidrsquos deal (4)
                                • Slide 35
                                • Strategies (2)
                                • (C)APD
                                • Treatment for CAPD
                                • Treatment for CAPD (2)
                                • Self-assessment
                                • Attention Deficit Hyperactivity Disorder
                                • Slide 42
                                • Attention Deficit Hyperactivity Disorder (2)
                                • (85 ndash X) x 365
                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                • Core symptoms
                                • Core symptoms (2)
                                • hellipand the rest of the criteria
                                • Slide 49
                                • Functional impact of core symptoms
                                • Functional impact of core symptoms (2)
                                • Functional impact of core symptoms (3)
                                • Slide 53
                                • Functional impact of core symptoms (4)
                                • Functional impact of core symptoms (5)
                                • Functional impact of core symptoms (6)
                                • Functional impact of core symptoms (7)
                                • Functional impact of core symptoms (8)
                                • Functional impact of core symptoms (9)
                                • Subtypes of ADHD
                                • Subtypes of ADHD (2)
                                • Common comorbidities with ADHD
                                • Slide 63
                                • Common comorbidities with ADHD (2)
                                • ADHD and girls
                                • Slide 66
                                • Slide 67
                                • ADHD and women
                                • Slide 69
                                • ADHD and women (2)
                                • Executive Functioning An Overarching Theme
                                • The Executive Functions
                                • The Executive Functions (2)
                                • Slide 74
                                • Slide 75
                                • Appropriate expectations
                                • Age-appropriate expectations
                                • Age-appropriate expectations (2)
                                • Age-appropriate expectations (3)
                                • Age-appropriate expectations (4)
                                • Age-appropriate expectations (5)
                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                • Slide 84
                                • Slide 85
                                • Strategies (3)
                                • Pharmacotherapy
                                • Behavioral Supports
                                • Slide 89
                                • Slide 90
                                • Slide 91
                                • Slide 92
                                • Slide 93
                                • Slide 94
                                • Slide 95
                                • Slide 96
                                • Slide 97
                                • Slide 98
                                • Slide 99
                                • Slide 100
                                • Slide 101
                                • Slide 102
                                • Slide 103
                                • Slide 104
                                • Slide 105
                                • Slide 106
                                • Slide 107
                                • Slide 108
                                • Slide 109
                                • Slide 110
                                • Time Out
                                • Token economy
                                • Slide 113
                                • Slide 114
                                • Slide 115
                                • Intrinsic motivation
                                • Slide 117
                                • Slide 118
                                • Slide 119
                                • Metacognition
                                • ldquoLend Me Your Brainrdquo
                                • What Does Dopamine Feel Like
                                • Preferred States What Does Dopamine Feel Like
                                • Slide 124
                                • PREFERRED STATES INVENTORY
                                • PREFERRED STATES INVENTORY (2)
                                • PREFERRED STATES INVENTORY (3)
                                • Slide 128
                                • Slide 129
                                • Broaden and Build
                                • ldquoNeuroMalleabilityrdquo
                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                • The reward-and-planning system
                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                • The reward-and-planning system (2)
                                • Ways the reward-and-planning system can go wrong
                                • Ways the reward-and-planning system can go wrong (2)
                                • Ways the reward-and-planning system can go wrong (3)
                                • Ways the reward-and-planning system can go wrong (4)
                                • Slide 141
                                • Lend Me Your Brain
                                • Ways the reward-and-planning system can go wrong (5)
                                • Ways the reward-and-planning system can go wrong (6)
                                • Ways the reward-and-planning system can go wrong (7)
                                • Slide 146
                                • Ways the reward-and-planning system can go wrong (8)
                                • Ways the reward-and-planning system can go wrong (9)
                                • Slide 149
                                • Ways the reward-and-planning system can go wrong (10)
                                • Ways the reward-and-planning system can go wrong (11)
                                • Slide 152
                                • Ways the reward-and-planning system can go wrong (12)
                                • Slide 154
                                • Ways the reward-and-planning system can go wrong (13)
                                • Ways the reward-and-planning system can go wrong (14)
                                • Slide 157
                                • Slide 158
                                • Slide 159
                                • Ways the reward-and-planning system can go wrong (15)
                                • Ways the reward-and-planning system can go wrong (16)
                                • Slide 162
                                • Ways the reward-and-planning system can go wrong (17)
                                • Slide 164
                                • Instant gratification vs executive gratification
                                • Slide 166
                                • Slide 167
                                • Slide 168
                                • Slide 169
                                • Slide 170
                                • Self-Talk Proficiency
                                • Self-Talk Proficiency (2)
                                • Self-Talk Proficiency (3)
                                • Self-Talk Proficiency (4)
                                • Match the Picture
                                • Slide 176
                                • Slide 177
                                • Distraction Delay Training
                                • Slide 179
                                • Slide 180
                                • Executive Estimates Training
                                • Learning Time
                                • Learning Time (2)
                                • Learning Time (3)
                                • Slide 185
                                • Slide 186
                                • Learning Time (4)
                                • Asking two questionshellip
                                • Slide 189
                                • Slide 190
                                • Key Features of Video Games
                                • Key Features of Video Games (2)
                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                • Slide 194
                                • Slide 195
                                • Slide 196
                                • Slide 197
                                • Slide 198
                                • Slide 199
                                • Slide 200
                                • Slide 201
                                • Quarterly QI review
                                • The post-mortem
                                • Slide 204
                                • Slide 205
                                • Slide 206
                                • Slide 207
                                • Slide 208
                                • Slide 209
                                • Slide 210
                                • The ldquoBig Fiverdquo
                                • Slide 212
                                • Slide 213
                                • The ldquoBig Fiverdquo (2)
                                • Slide 215
                                • Slide 216
                                • Slide 217
                                • The ldquoBig Fiverdquo (3)
                                • The ldquoBig Fiverdquo (4)
                                • The ldquoBig Fiverdquo (5)
                                • A challengehellip
                                • Slide 222

                                  Regulatory-Sensory Processing Disorders

                                  Treatment ldquotop downrdquo ldquobottom uprdquo

                                  Central Auditory Processing Disorder

                                  bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                                  Central Auditory Processing Disorder

                                  Central Auditory Processing Disorder

                                  CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                                  Central Auditory Processing Disorder

                                  - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                                  Central Auditory Processing Disorder

                                  - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                                  CAPD or ADHD

                                  Whatrsquos the kidrsquos deal

                                  Strategies

                                  (C)APD

                                  Treatment ldquotop downrdquo ldquobottom uprdquo

                                  X

                                  Treatment for CAPD

                                  Environmental modifications

                                  Treatment for CAPD

                                  Compensatory Strategies

                                  Self-assessment

                                  >

                                  Attention Deficit Hyperactivity Disorder

                                  Increase salience

                                  Attention Deficit Hyperactivity Disorder

                                  (85 ndash X) x 365

                                  ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                  Core symptoms

                                  Inattention distractibility

                                  Core symptoms

                                  Hyperactivity impulsivity

                                  hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                  mental disorder

                                  Functional impact of core symptoms

                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                  Functional impact of core symptoms

                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                  Functional impact of core symptoms

                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                  Functional impact of core symptoms

                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                  Functional impact of core symptoms

                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                  Functional impact of core symptoms

                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                  Functional impact of core symptoms

                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                  Functional impact of core symptoms

                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                  Functional impact of core symptoms

                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                  Subtypes of ADHD

                                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                  Subtypes of ADHD

                                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                  Specifed

                                  Common comorbidities with ADHD

                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                  processing challenges

                                  Common comorbidities with ADHD

                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                  processing challenges

                                  ADHD and girls

                                  ADHD and women

                                  ADHD and women

                                  More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                  partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                  disorganization

                                  Executive FunctioningAn Overarching Theme

                                  Sensory Processing Disorder Central Auditory Processing

                                  Disorder ADHD and Executive Dysfunction

                                  The Executive Functions

                                  Internalizing speech Previewing

                                  Prioritizing Tempo control Inhibition

                                  The Executive Functions

                                  Determining salience (whatrsquos in it for me)

                                  Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                  Appropriate expectations

                                  Age-appropriate expectations

                                  Preschool 1-step errands Chores with cues Basic inhibition

                                  Age-appropriate expectations

                                  K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                  3rd ndash 5th

                                  Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                  Age-appropriate expectations

                                  6th ndash 8th

                                  complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                  Age-appropriate expectations

                                  Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                  already made Take othersrsquo perspective

                                  Age-appropriate expectations

                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                  Inter-connectedness of systems Cortico-striatal system for example

                                  Strategies

                                  Pharmacotherapy

                                  X

                                  Behavioral Supports

                                  A B C

                                  A B C

                                  behavior

                                  A B C

                                  consequences

                                  A B C

                                  antecedent

                                  A B C

                                  A B C

                                  antecedent

                                  A B C

                                  antecedent

                                  easy hard

                                  A B C

                                  consequences

                                  R P

                                  +

                                  -

                                  R+ P+

                                  R- P-

                                  Time Out

                                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                  Token economy

                                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                  Intrinsic motivation

                                  A B C

                                  consequencesX

                                  A B C

                                  behavior

                                  Metacognition

                                  Metacognitive knowledge Metacognitive strategies

                                  ldquoLend Me Your Brainrdquo

                                  What Does Dopamine Feel Like

                                  The Physiology of Motivation and Reward

                                  Preferred States What Does Dopamine Feel Like

                                  1 Great experience2 Kodak moment3 The feeeeling

                                  David D Nowell PhD189 May Street

                                  Worcester Mass 01602DrNowellcom

                                  PREFERRED STATES INVENTORY

                                  wwwLulucom

                                  Identify 20 peak experiences For each peak experience identify the

                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                  of that moment Name it Check the 20 peak moment-feelings for

                                  clusters groupings There will probably be 4 or 5

                                  PREFERRED STATES INVENTORY

                                  Find a word a label for each of the groupings

                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                  ldquovaluesrdquo ways that you really like to feel

                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                  PREFERRED STATES INVENTORY

                                  PREFERRED STATES INVENTORY

                                  Broaden and Build

                                  ldquoNeuroMalleabilityrdquo

                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                  The reward-and-planning system

                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                  The reward-and-planning system

                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                  Ways the reward-and-planning system can go wrong

                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                  Ways the reward-and-planning system can go wrong

                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                  Ways the reward-and-planning system can go wrong

                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                  Ways the reward-and-planning system can go wrong

                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                  Lend Me Your Brain

                                  Supporting Clients with Executive Dysfunction

                                  Ways the reward-and-planning system can go wrong

                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                  Ways the reward-and-planning system can go wrong

                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                  Ways the reward-and-planning system can go wrong

                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                  Ways the reward-and-planning system can go wrong

                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                  Too busy with current activity

                                  Field dependent

                                  Ways the reward-and-planning system can go wrong

                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                  Ways the reward-and-planning system can go wrong

                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                  Ways the reward-and-planning system can go wrong

                                  Sequence problem-solve

                                  Ways the reward-and-planning system can go wrong

                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                  Ways the reward-and-planning system can go wrong

                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                  Ways the reward-and-planning system can go wrong

                                  Block out distractions

                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                  - E Goldberg

                                  Ways the reward-and-planning system can go wrong

                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                  Ways the reward-and-planning system can go wrong

                                  Get the reward

                                  Ways the reward-and-planning system can go wrong

                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                  Instant gratification vs

                                  executive gratification

                                  A B C

                                  behaviorx

                                  Self-Talk Proficiency

                                  Self-Talk Proficiency

                                  bull -ldquoHow are you going to know when to be readyrdquo

                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                  takerdquordquo

                                  Self-Talk Proficiency

                                  bull -ldquoHow are you going to know what you needrdquo

                                  bull -ldquoHow are you going to know what is most importantrdquo

                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                  bull -ldquoHow will you know when you are donerdquo

                                  Self-Talk Proficiency

                                  bull -ldquoHow will you continue when you are tiredrdquo

                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                  differentlyrdquo ldquoWho will be the first person to notice

                                  thathelliprdquo

                                  Match the Picture

                                  Distraction Delay Training

                                  Executive Estimates Training

                                  X

                                  Learning Time

                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                  Learning Time

                                  Learning Time

                                  Learning Time

                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                  Asking two questionshellip

                                  Am I having fun now And is this what I set out to do

                                  Am I having fun nowIs

                                  this

                                  what

                                  I se

                                  t out

                                  to

                                  do

                                  bullYesbullYes

                                  bullNobullYes

                                  bullYesbullNo

                                  bullNobullNo

                                  Am I having fun nowIs

                                  this

                                  what

                                  I se

                                  t out

                                  to

                                  do

                                  bullFunbullOn-task

                                  bullNot funbullOn-task

                                  bullFunbullNot on-task

                                  bullNot funbullNot on-task

                                  Key Features of Video Games

                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                  inappropriate behavior ndash never reverse this

                                  Key Features of Video Games

                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                  Volkow et al 2004

                                  Increase salience

                                  Increase salience

                                  Quarterly QI review

                                  The post-mortem

                                  Your 1 Organizational Tool

                                  Your 1 Organizational Tool

                                  Yoga read

                                  Staff meeting

                                  Planningsession

                                  Phone calls

                                  billing

                                  Your 1 Organizational Tool

                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                  Your 1 Organizational Tool

                                  Learn French

                                  Stop smoking

                                  Be a better spouse

                                  The ldquoBig Fiverdquo

                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                  The ldquoBig Fiverdquo

                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                  The ldquoBig Fiverdquo

                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                  The ldquoBig Fiverdquo

                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                  The ldquoBig Fiverdquo

                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                  A CHALLENGEhellip

                                  wwwDrNowellcom

                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                  DavidNowellSeminars

                                  DavidNowell

                                  • Slide 1
                                  • hellipa challenge
                                  • Slide 3
                                  • Perspective of this workshophellip
                                  • ldquoTop ndash downrdquo dysfunction
                                  • ldquoBottom - uprdquo dysfunction
                                  • Slide 7
                                  • Whatrsquos the kidrsquos deal
                                  • Overview
                                  • This Dense Pudding
                                  • Sensory Processing Disorder
                                  • Slide 12
                                  • Slide 13
                                  • Developmental considerations
                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                  • Whatrsquos the kidrsquos deal (2)
                                  • Slide 17
                                  • Whatrsquos the kidrsquos deal (3)
                                  • Slide 19
                                  • Strategies
                                  • Regulatory-Sensory Processing Disorders
                                  • Slide 22
                                  • Slide 23
                                  • Regulatory-Sensory Processing Disorders (2)
                                  • Slide 25
                                  • Central Auditory Processing Disorder
                                  • Slide 27
                                  • Slide 28
                                  • Slide 29
                                  • Central Auditory Processing Disorder (2)
                                  • Central Auditory Processing Disorder (3)
                                  • Central Auditory Processing Disorder (4)
                                  • CAPD or ADHD
                                  • Whatrsquos the kidrsquos deal (4)
                                  • Slide 35
                                  • Strategies (2)
                                  • (C)APD
                                  • Treatment for CAPD
                                  • Treatment for CAPD (2)
                                  • Self-assessment
                                  • Attention Deficit Hyperactivity Disorder
                                  • Slide 42
                                  • Attention Deficit Hyperactivity Disorder (2)
                                  • (85 ndash X) x 365
                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                  • Core symptoms
                                  • Core symptoms (2)
                                  • hellipand the rest of the criteria
                                  • Slide 49
                                  • Functional impact of core symptoms
                                  • Functional impact of core symptoms (2)
                                  • Functional impact of core symptoms (3)
                                  • Slide 53
                                  • Functional impact of core symptoms (4)
                                  • Functional impact of core symptoms (5)
                                  • Functional impact of core symptoms (6)
                                  • Functional impact of core symptoms (7)
                                  • Functional impact of core symptoms (8)
                                  • Functional impact of core symptoms (9)
                                  • Subtypes of ADHD
                                  • Subtypes of ADHD (2)
                                  • Common comorbidities with ADHD
                                  • Slide 63
                                  • Common comorbidities with ADHD (2)
                                  • ADHD and girls
                                  • Slide 66
                                  • Slide 67
                                  • ADHD and women
                                  • Slide 69
                                  • ADHD and women (2)
                                  • Executive Functioning An Overarching Theme
                                  • The Executive Functions
                                  • The Executive Functions (2)
                                  • Slide 74
                                  • Slide 75
                                  • Appropriate expectations
                                  • Age-appropriate expectations
                                  • Age-appropriate expectations (2)
                                  • Age-appropriate expectations (3)
                                  • Age-appropriate expectations (4)
                                  • Age-appropriate expectations (5)
                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                  • Slide 84
                                  • Slide 85
                                  • Strategies (3)
                                  • Pharmacotherapy
                                  • Behavioral Supports
                                  • Slide 89
                                  • Slide 90
                                  • Slide 91
                                  • Slide 92
                                  • Slide 93
                                  • Slide 94
                                  • Slide 95
                                  • Slide 96
                                  • Slide 97
                                  • Slide 98
                                  • Slide 99
                                  • Slide 100
                                  • Slide 101
                                  • Slide 102
                                  • Slide 103
                                  • Slide 104
                                  • Slide 105
                                  • Slide 106
                                  • Slide 107
                                  • Slide 108
                                  • Slide 109
                                  • Slide 110
                                  • Time Out
                                  • Token economy
                                  • Slide 113
                                  • Slide 114
                                  • Slide 115
                                  • Intrinsic motivation
                                  • Slide 117
                                  • Slide 118
                                  • Slide 119
                                  • Metacognition
                                  • ldquoLend Me Your Brainrdquo
                                  • What Does Dopamine Feel Like
                                  • Preferred States What Does Dopamine Feel Like
                                  • Slide 124
                                  • PREFERRED STATES INVENTORY
                                  • PREFERRED STATES INVENTORY (2)
                                  • PREFERRED STATES INVENTORY (3)
                                  • Slide 128
                                  • Slide 129
                                  • Broaden and Build
                                  • ldquoNeuroMalleabilityrdquo
                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                  • The reward-and-planning system
                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                  • The reward-and-planning system (2)
                                  • Ways the reward-and-planning system can go wrong
                                  • Ways the reward-and-planning system can go wrong (2)
                                  • Ways the reward-and-planning system can go wrong (3)
                                  • Ways the reward-and-planning system can go wrong (4)
                                  • Slide 141
                                  • Lend Me Your Brain
                                  • Ways the reward-and-planning system can go wrong (5)
                                  • Ways the reward-and-planning system can go wrong (6)
                                  • Ways the reward-and-planning system can go wrong (7)
                                  • Slide 146
                                  • Ways the reward-and-planning system can go wrong (8)
                                  • Ways the reward-and-planning system can go wrong (9)
                                  • Slide 149
                                  • Ways the reward-and-planning system can go wrong (10)
                                  • Ways the reward-and-planning system can go wrong (11)
                                  • Slide 152
                                  • Ways the reward-and-planning system can go wrong (12)
                                  • Slide 154
                                  • Ways the reward-and-planning system can go wrong (13)
                                  • Ways the reward-and-planning system can go wrong (14)
                                  • Slide 157
                                  • Slide 158
                                  • Slide 159
                                  • Ways the reward-and-planning system can go wrong (15)
                                  • Ways the reward-and-planning system can go wrong (16)
                                  • Slide 162
                                  • Ways the reward-and-planning system can go wrong (17)
                                  • Slide 164
                                  • Instant gratification vs executive gratification
                                  • Slide 166
                                  • Slide 167
                                  • Slide 168
                                  • Slide 169
                                  • Slide 170
                                  • Self-Talk Proficiency
                                  • Self-Talk Proficiency (2)
                                  • Self-Talk Proficiency (3)
                                  • Self-Talk Proficiency (4)
                                  • Match the Picture
                                  • Slide 176
                                  • Slide 177
                                  • Distraction Delay Training
                                  • Slide 179
                                  • Slide 180
                                  • Executive Estimates Training
                                  • Learning Time
                                  • Learning Time (2)
                                  • Learning Time (3)
                                  • Slide 185
                                  • Slide 186
                                  • Learning Time (4)
                                  • Asking two questionshellip
                                  • Slide 189
                                  • Slide 190
                                  • Key Features of Video Games
                                  • Key Features of Video Games (2)
                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                  • Slide 194
                                  • Slide 195
                                  • Slide 196
                                  • Slide 197
                                  • Slide 198
                                  • Slide 199
                                  • Slide 200
                                  • Slide 201
                                  • Quarterly QI review
                                  • The post-mortem
                                  • Slide 204
                                  • Slide 205
                                  • Slide 206
                                  • Slide 207
                                  • Slide 208
                                  • Slide 209
                                  • Slide 210
                                  • The ldquoBig Fiverdquo
                                  • Slide 212
                                  • Slide 213
                                  • The ldquoBig Fiverdquo (2)
                                  • Slide 215
                                  • Slide 216
                                  • Slide 217
                                  • The ldquoBig Fiverdquo (3)
                                  • The ldquoBig Fiverdquo (4)
                                  • The ldquoBig Fiverdquo (5)
                                  • A challengehellip
                                  • Slide 222

                                    Central Auditory Processing Disorder

                                    bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                                    Central Auditory Processing Disorder

                                    Central Auditory Processing Disorder

                                    CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                                    Central Auditory Processing Disorder

                                    - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                                    Central Auditory Processing Disorder

                                    - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                                    CAPD or ADHD

                                    Whatrsquos the kidrsquos deal

                                    Strategies

                                    (C)APD

                                    Treatment ldquotop downrdquo ldquobottom uprdquo

                                    X

                                    Treatment for CAPD

                                    Environmental modifications

                                    Treatment for CAPD

                                    Compensatory Strategies

                                    Self-assessment

                                    >

                                    Attention Deficit Hyperactivity Disorder

                                    Increase salience

                                    Attention Deficit Hyperactivity Disorder

                                    (85 ndash X) x 365

                                    ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                    Core symptoms

                                    Inattention distractibility

                                    Core symptoms

                                    Hyperactivity impulsivity

                                    hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                    mental disorder

                                    Functional impact of core symptoms

                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                    Functional impact of core symptoms

                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                    Functional impact of core symptoms

                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                    Functional impact of core symptoms

                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                    Functional impact of core symptoms

                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                    Functional impact of core symptoms

                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                    Functional impact of core symptoms

                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                    Functional impact of core symptoms

                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                    Functional impact of core symptoms

                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                    Subtypes of ADHD

                                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                    Subtypes of ADHD

                                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                    Specifed

                                    Common comorbidities with ADHD

                                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                    processing challenges

                                    Common comorbidities with ADHD

                                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                    processing challenges

                                    ADHD and girls

                                    ADHD and women

                                    ADHD and women

                                    More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                    partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                    disorganization

                                    Executive FunctioningAn Overarching Theme

                                    Sensory Processing Disorder Central Auditory Processing

                                    Disorder ADHD and Executive Dysfunction

                                    The Executive Functions

                                    Internalizing speech Previewing

                                    Prioritizing Tempo control Inhibition

                                    The Executive Functions

                                    Determining salience (whatrsquos in it for me)

                                    Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                    Appropriate expectations

                                    Age-appropriate expectations

                                    Preschool 1-step errands Chores with cues Basic inhibition

                                    Age-appropriate expectations

                                    K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                    3rd ndash 5th

                                    Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                    Age-appropriate expectations

                                    6th ndash 8th

                                    complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                    Age-appropriate expectations

                                    Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                    already made Take othersrsquo perspective

                                    Age-appropriate expectations

                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                    Inter-connectedness of systems Cortico-striatal system for example

                                    Strategies

                                    Pharmacotherapy

                                    X

                                    Behavioral Supports

                                    A B C

                                    A B C

                                    behavior

                                    A B C

                                    consequences

                                    A B C

                                    antecedent

                                    A B C

                                    A B C

                                    antecedent

                                    A B C

                                    antecedent

                                    easy hard

                                    A B C

                                    consequences

                                    R P

                                    +

                                    -

                                    R+ P+

                                    R- P-

                                    Time Out

                                    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                    Token economy

                                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                    Intrinsic motivation

                                    A B C

                                    consequencesX

                                    A B C

                                    behavior

                                    Metacognition

                                    Metacognitive knowledge Metacognitive strategies

                                    ldquoLend Me Your Brainrdquo

                                    What Does Dopamine Feel Like

                                    The Physiology of Motivation and Reward

                                    Preferred States What Does Dopamine Feel Like

                                    1 Great experience2 Kodak moment3 The feeeeling

                                    David D Nowell PhD189 May Street

                                    Worcester Mass 01602DrNowellcom

                                    PREFERRED STATES INVENTORY

                                    wwwLulucom

                                    Identify 20 peak experiences For each peak experience identify the

                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                    of that moment Name it Check the 20 peak moment-feelings for

                                    clusters groupings There will probably be 4 or 5

                                    PREFERRED STATES INVENTORY

                                    Find a word a label for each of the groupings

                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                    ldquovaluesrdquo ways that you really like to feel

                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                    PREFERRED STATES INVENTORY

                                    PREFERRED STATES INVENTORY

                                    Broaden and Build

                                    ldquoNeuroMalleabilityrdquo

                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                    The reward-and-planning system

                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                    The reward-and-planning system

                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                    Ways the reward-and-planning system can go wrong

                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                    Ways the reward-and-planning system can go wrong

                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                    Ways the reward-and-planning system can go wrong

                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                    Ways the reward-and-planning system can go wrong

                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                    Lend Me Your Brain

                                    Supporting Clients with Executive Dysfunction

                                    Ways the reward-and-planning system can go wrong

                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                    Ways the reward-and-planning system can go wrong

                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                    Ways the reward-and-planning system can go wrong

                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                    Ways the reward-and-planning system can go wrong

                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                    Too busy with current activity

                                    Field dependent

                                    Ways the reward-and-planning system can go wrong

                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                    Ways the reward-and-planning system can go wrong

                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                    Ways the reward-and-planning system can go wrong

                                    Sequence problem-solve

                                    Ways the reward-and-planning system can go wrong

                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                    Ways the reward-and-planning system can go wrong

                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                    Ways the reward-and-planning system can go wrong

                                    Block out distractions

                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                    - E Goldberg

                                    Ways the reward-and-planning system can go wrong

                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                    Ways the reward-and-planning system can go wrong

                                    Get the reward

                                    Ways the reward-and-planning system can go wrong

                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                    Instant gratification vs

                                    executive gratification

                                    A B C

                                    behaviorx

                                    Self-Talk Proficiency

                                    Self-Talk Proficiency

                                    bull -ldquoHow are you going to know when to be readyrdquo

                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                    takerdquordquo

                                    Self-Talk Proficiency

                                    bull -ldquoHow are you going to know what you needrdquo

                                    bull -ldquoHow are you going to know what is most importantrdquo

                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                    bull -ldquoHow will you know when you are donerdquo

                                    Self-Talk Proficiency

                                    bull -ldquoHow will you continue when you are tiredrdquo

                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                    differentlyrdquo ldquoWho will be the first person to notice

                                    thathelliprdquo

                                    Match the Picture

                                    Distraction Delay Training

                                    Executive Estimates Training

                                    X

                                    Learning Time

                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                    Learning Time

                                    Learning Time

                                    Learning Time

                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                    Asking two questionshellip

                                    Am I having fun now And is this what I set out to do

                                    Am I having fun nowIs

                                    this

                                    what

                                    I se

                                    t out

                                    to

                                    do

                                    bullYesbullYes

                                    bullNobullYes

                                    bullYesbullNo

                                    bullNobullNo

                                    Am I having fun nowIs

                                    this

                                    what

                                    I se

                                    t out

                                    to

                                    do

                                    bullFunbullOn-task

                                    bullNot funbullOn-task

                                    bullFunbullNot on-task

                                    bullNot funbullNot on-task

                                    Key Features of Video Games

                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                    inappropriate behavior ndash never reverse this

                                    Key Features of Video Games

                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                    Volkow et al 2004

                                    Increase salience

                                    Increase salience

                                    Quarterly QI review

                                    The post-mortem

                                    Your 1 Organizational Tool

                                    Your 1 Organizational Tool

                                    Yoga read

                                    Staff meeting

                                    Planningsession

                                    Phone calls

                                    billing

                                    Your 1 Organizational Tool

                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                    Your 1 Organizational Tool

                                    Learn French

                                    Stop smoking

                                    Be a better spouse

                                    The ldquoBig Fiverdquo

                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                    The ldquoBig Fiverdquo

                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                    The ldquoBig Fiverdquo

                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                    The ldquoBig Fiverdquo

                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                    The ldquoBig Fiverdquo

                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                    A CHALLENGEhellip

                                    wwwDrNowellcom

                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                    DavidNowellSeminars

                                    DavidNowell

                                    • Slide 1
                                    • hellipa challenge
                                    • Slide 3
                                    • Perspective of this workshophellip
                                    • ldquoTop ndash downrdquo dysfunction
                                    • ldquoBottom - uprdquo dysfunction
                                    • Slide 7
                                    • Whatrsquos the kidrsquos deal
                                    • Overview
                                    • This Dense Pudding
                                    • Sensory Processing Disorder
                                    • Slide 12
                                    • Slide 13
                                    • Developmental considerations
                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                    • Whatrsquos the kidrsquos deal (2)
                                    • Slide 17
                                    • Whatrsquos the kidrsquos deal (3)
                                    • Slide 19
                                    • Strategies
                                    • Regulatory-Sensory Processing Disorders
                                    • Slide 22
                                    • Slide 23
                                    • Regulatory-Sensory Processing Disorders (2)
                                    • Slide 25
                                    • Central Auditory Processing Disorder
                                    • Slide 27
                                    • Slide 28
                                    • Slide 29
                                    • Central Auditory Processing Disorder (2)
                                    • Central Auditory Processing Disorder (3)
                                    • Central Auditory Processing Disorder (4)
                                    • CAPD or ADHD
                                    • Whatrsquos the kidrsquos deal (4)
                                    • Slide 35
                                    • Strategies (2)
                                    • (C)APD
                                    • Treatment for CAPD
                                    • Treatment for CAPD (2)
                                    • Self-assessment
                                    • Attention Deficit Hyperactivity Disorder
                                    • Slide 42
                                    • Attention Deficit Hyperactivity Disorder (2)
                                    • (85 ndash X) x 365
                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                    • Core symptoms
                                    • Core symptoms (2)
                                    • hellipand the rest of the criteria
                                    • Slide 49
                                    • Functional impact of core symptoms
                                    • Functional impact of core symptoms (2)
                                    • Functional impact of core symptoms (3)
                                    • Slide 53
                                    • Functional impact of core symptoms (4)
                                    • Functional impact of core symptoms (5)
                                    • Functional impact of core symptoms (6)
                                    • Functional impact of core symptoms (7)
                                    • Functional impact of core symptoms (8)
                                    • Functional impact of core symptoms (9)
                                    • Subtypes of ADHD
                                    • Subtypes of ADHD (2)
                                    • Common comorbidities with ADHD
                                    • Slide 63
                                    • Common comorbidities with ADHD (2)
                                    • ADHD and girls
                                    • Slide 66
                                    • Slide 67
                                    • ADHD and women
                                    • Slide 69
                                    • ADHD and women (2)
                                    • Executive Functioning An Overarching Theme
                                    • The Executive Functions
                                    • The Executive Functions (2)
                                    • Slide 74
                                    • Slide 75
                                    • Appropriate expectations
                                    • Age-appropriate expectations
                                    • Age-appropriate expectations (2)
                                    • Age-appropriate expectations (3)
                                    • Age-appropriate expectations (4)
                                    • Age-appropriate expectations (5)
                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                    • Slide 84
                                    • Slide 85
                                    • Strategies (3)
                                    • Pharmacotherapy
                                    • Behavioral Supports
                                    • Slide 89
                                    • Slide 90
                                    • Slide 91
                                    • Slide 92
                                    • Slide 93
                                    • Slide 94
                                    • Slide 95
                                    • Slide 96
                                    • Slide 97
                                    • Slide 98
                                    • Slide 99
                                    • Slide 100
                                    • Slide 101
                                    • Slide 102
                                    • Slide 103
                                    • Slide 104
                                    • Slide 105
                                    • Slide 106
                                    • Slide 107
                                    • Slide 108
                                    • Slide 109
                                    • Slide 110
                                    • Time Out
                                    • Token economy
                                    • Slide 113
                                    • Slide 114
                                    • Slide 115
                                    • Intrinsic motivation
                                    • Slide 117
                                    • Slide 118
                                    • Slide 119
                                    • Metacognition
                                    • ldquoLend Me Your Brainrdquo
                                    • What Does Dopamine Feel Like
                                    • Preferred States What Does Dopamine Feel Like
                                    • Slide 124
                                    • PREFERRED STATES INVENTORY
                                    • PREFERRED STATES INVENTORY (2)
                                    • PREFERRED STATES INVENTORY (3)
                                    • Slide 128
                                    • Slide 129
                                    • Broaden and Build
                                    • ldquoNeuroMalleabilityrdquo
                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                    • The reward-and-planning system
                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                    • The reward-and-planning system (2)
                                    • Ways the reward-and-planning system can go wrong
                                    • Ways the reward-and-planning system can go wrong (2)
                                    • Ways the reward-and-planning system can go wrong (3)
                                    • Ways the reward-and-planning system can go wrong (4)
                                    • Slide 141
                                    • Lend Me Your Brain
                                    • Ways the reward-and-planning system can go wrong (5)
                                    • Ways the reward-and-planning system can go wrong (6)
                                    • Ways the reward-and-planning system can go wrong (7)
                                    • Slide 146
                                    • Ways the reward-and-planning system can go wrong (8)
                                    • Ways the reward-and-planning system can go wrong (9)
                                    • Slide 149
                                    • Ways the reward-and-planning system can go wrong (10)
                                    • Ways the reward-and-planning system can go wrong (11)
                                    • Slide 152
                                    • Ways the reward-and-planning system can go wrong (12)
                                    • Slide 154
                                    • Ways the reward-and-planning system can go wrong (13)
                                    • Ways the reward-and-planning system can go wrong (14)
                                    • Slide 157
                                    • Slide 158
                                    • Slide 159
                                    • Ways the reward-and-planning system can go wrong (15)
                                    • Ways the reward-and-planning system can go wrong (16)
                                    • Slide 162
                                    • Ways the reward-and-planning system can go wrong (17)
                                    • Slide 164
                                    • Instant gratification vs executive gratification
                                    • Slide 166
                                    • Slide 167
                                    • Slide 168
                                    • Slide 169
                                    • Slide 170
                                    • Self-Talk Proficiency
                                    • Self-Talk Proficiency (2)
                                    • Self-Talk Proficiency (3)
                                    • Self-Talk Proficiency (4)
                                    • Match the Picture
                                    • Slide 176
                                    • Slide 177
                                    • Distraction Delay Training
                                    • Slide 179
                                    • Slide 180
                                    • Executive Estimates Training
                                    • Learning Time
                                    • Learning Time (2)
                                    • Learning Time (3)
                                    • Slide 185
                                    • Slide 186
                                    • Learning Time (4)
                                    • Asking two questionshellip
                                    • Slide 189
                                    • Slide 190
                                    • Key Features of Video Games
                                    • Key Features of Video Games (2)
                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                    • Slide 194
                                    • Slide 195
                                    • Slide 196
                                    • Slide 197
                                    • Slide 198
                                    • Slide 199
                                    • Slide 200
                                    • Slide 201
                                    • Quarterly QI review
                                    • The post-mortem
                                    • Slide 204
                                    • Slide 205
                                    • Slide 206
                                    • Slide 207
                                    • Slide 208
                                    • Slide 209
                                    • Slide 210
                                    • The ldquoBig Fiverdquo
                                    • Slide 212
                                    • Slide 213
                                    • The ldquoBig Fiverdquo (2)
                                    • Slide 215
                                    • Slide 216
                                    • Slide 217
                                    • The ldquoBig Fiverdquo (3)
                                    • The ldquoBig Fiverdquo (4)
                                    • The ldquoBig Fiverdquo (5)
                                    • A challengehellip
                                    • Slide 222

                                      bull Auditory discrimination (samedifferent)bull Auditory closure (fill in missing bits)bull Auditory localisation (locate source of sound)bull Auditory performance with degraded acousticsignalbull Auditory figure-ground (perceiving sounds inbackground noise)

                                      Central Auditory Processing Disorder

                                      Central Auditory Processing Disorder

                                      CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                                      Central Auditory Processing Disorder

                                      - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                                      Central Auditory Processing Disorder

                                      - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                                      CAPD or ADHD

                                      Whatrsquos the kidrsquos deal

                                      Strategies

                                      (C)APD

                                      Treatment ldquotop downrdquo ldquobottom uprdquo

                                      X

                                      Treatment for CAPD

                                      Environmental modifications

                                      Treatment for CAPD

                                      Compensatory Strategies

                                      Self-assessment

                                      >

                                      Attention Deficit Hyperactivity Disorder

                                      Increase salience

                                      Attention Deficit Hyperactivity Disorder

                                      (85 ndash X) x 365

                                      ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                      Core symptoms

                                      Inattention distractibility

                                      Core symptoms

                                      Hyperactivity impulsivity

                                      hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                      mental disorder

                                      Functional impact of core symptoms

                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                      Functional impact of core symptoms

                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                      Functional impact of core symptoms

                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                      Functional impact of core symptoms

                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                      Functional impact of core symptoms

                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                      Functional impact of core symptoms

                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                      Functional impact of core symptoms

                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                      Functional impact of core symptoms

                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                      Functional impact of core symptoms

                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                      Subtypes of ADHD

                                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                      Subtypes of ADHD

                                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                      Specifed

                                      Common comorbidities with ADHD

                                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                      processing challenges

                                      Common comorbidities with ADHD

                                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                      processing challenges

                                      ADHD and girls

                                      ADHD and women

                                      ADHD and women

                                      More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                      partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                      disorganization

                                      Executive FunctioningAn Overarching Theme

                                      Sensory Processing Disorder Central Auditory Processing

                                      Disorder ADHD and Executive Dysfunction

                                      The Executive Functions

                                      Internalizing speech Previewing

                                      Prioritizing Tempo control Inhibition

                                      The Executive Functions

                                      Determining salience (whatrsquos in it for me)

                                      Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                      Appropriate expectations

                                      Age-appropriate expectations

                                      Preschool 1-step errands Chores with cues Basic inhibition

                                      Age-appropriate expectations

                                      K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                      3rd ndash 5th

                                      Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                      Age-appropriate expectations

                                      6th ndash 8th

                                      complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                      Age-appropriate expectations

                                      Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                      already made Take othersrsquo perspective

                                      Age-appropriate expectations

                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                      Inter-connectedness of systems Cortico-striatal system for example

                                      Strategies

                                      Pharmacotherapy

                                      X

                                      Behavioral Supports

                                      A B C

                                      A B C

                                      behavior

                                      A B C

                                      consequences

                                      A B C

                                      antecedent

                                      A B C

                                      A B C

                                      antecedent

                                      A B C

                                      antecedent

                                      easy hard

                                      A B C

                                      consequences

                                      R P

                                      +

                                      -

                                      R+ P+

                                      R- P-

                                      Time Out

                                      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                      Token economy

                                      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                      Intrinsic motivation

                                      A B C

                                      consequencesX

                                      A B C

                                      behavior

                                      Metacognition

                                      Metacognitive knowledge Metacognitive strategies

                                      ldquoLend Me Your Brainrdquo

                                      What Does Dopamine Feel Like

                                      The Physiology of Motivation and Reward

                                      Preferred States What Does Dopamine Feel Like

                                      1 Great experience2 Kodak moment3 The feeeeling

                                      David D Nowell PhD189 May Street

                                      Worcester Mass 01602DrNowellcom

                                      PREFERRED STATES INVENTORY

                                      wwwLulucom

                                      Identify 20 peak experiences For each peak experience identify the

                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                      of that moment Name it Check the 20 peak moment-feelings for

                                      clusters groupings There will probably be 4 or 5

                                      PREFERRED STATES INVENTORY

                                      Find a word a label for each of the groupings

                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                      ldquovaluesrdquo ways that you really like to feel

                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                      PREFERRED STATES INVENTORY

                                      PREFERRED STATES INVENTORY

                                      Broaden and Build

                                      ldquoNeuroMalleabilityrdquo

                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                      The reward-and-planning system

                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                      The reward-and-planning system

                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                      Ways the reward-and-planning system can go wrong

                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                      Ways the reward-and-planning system can go wrong

                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                      Ways the reward-and-planning system can go wrong

                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                      Ways the reward-and-planning system can go wrong

                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                      Lend Me Your Brain

                                      Supporting Clients with Executive Dysfunction

                                      Ways the reward-and-planning system can go wrong

                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                      Ways the reward-and-planning system can go wrong

                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                      Ways the reward-and-planning system can go wrong

                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                      Ways the reward-and-planning system can go wrong

                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                      Too busy with current activity

                                      Field dependent

                                      Ways the reward-and-planning system can go wrong

                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                      Ways the reward-and-planning system can go wrong

                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                      Ways the reward-and-planning system can go wrong

                                      Sequence problem-solve

                                      Ways the reward-and-planning system can go wrong

                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                      Ways the reward-and-planning system can go wrong

                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                      Ways the reward-and-planning system can go wrong

                                      Block out distractions

                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                      - E Goldberg

                                      Ways the reward-and-planning system can go wrong

                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                      Ways the reward-and-planning system can go wrong

                                      Get the reward

                                      Ways the reward-and-planning system can go wrong

                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                      Instant gratification vs

                                      executive gratification

                                      A B C

                                      behaviorx

                                      Self-Talk Proficiency

                                      Self-Talk Proficiency

                                      bull -ldquoHow are you going to know when to be readyrdquo

                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                      takerdquordquo

                                      Self-Talk Proficiency

                                      bull -ldquoHow are you going to know what you needrdquo

                                      bull -ldquoHow are you going to know what is most importantrdquo

                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                      bull -ldquoHow will you know when you are donerdquo

                                      Self-Talk Proficiency

                                      bull -ldquoHow will you continue when you are tiredrdquo

                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                      differentlyrdquo ldquoWho will be the first person to notice

                                      thathelliprdquo

                                      Match the Picture

                                      Distraction Delay Training

                                      Executive Estimates Training

                                      X

                                      Learning Time

                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                      Learning Time

                                      Learning Time

                                      Learning Time

                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                      Asking two questionshellip

                                      Am I having fun now And is this what I set out to do

                                      Am I having fun nowIs

                                      this

                                      what

                                      I se

                                      t out

                                      to

                                      do

                                      bullYesbullYes

                                      bullNobullYes

                                      bullYesbullNo

                                      bullNobullNo

                                      Am I having fun nowIs

                                      this

                                      what

                                      I se

                                      t out

                                      to

                                      do

                                      bullFunbullOn-task

                                      bullNot funbullOn-task

                                      bullFunbullNot on-task

                                      bullNot funbullNot on-task

                                      Key Features of Video Games

                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                      inappropriate behavior ndash never reverse this

                                      Key Features of Video Games

                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                      Volkow et al 2004

                                      Increase salience

                                      Increase salience

                                      Quarterly QI review

                                      The post-mortem

                                      Your 1 Organizational Tool

                                      Your 1 Organizational Tool

                                      Yoga read

                                      Staff meeting

                                      Planningsession

                                      Phone calls

                                      billing

                                      Your 1 Organizational Tool

                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                      Your 1 Organizational Tool

                                      Learn French

                                      Stop smoking

                                      Be a better spouse

                                      The ldquoBig Fiverdquo

                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                      The ldquoBig Fiverdquo

                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                      The ldquoBig Fiverdquo

                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                      The ldquoBig Fiverdquo

                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                      The ldquoBig Fiverdquo

                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                      A CHALLENGEhellip

                                      wwwDrNowellcom

                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                      DavidNowellSeminars

                                      DavidNowell

                                      • Slide 1
                                      • hellipa challenge
                                      • Slide 3
                                      • Perspective of this workshophellip
                                      • ldquoTop ndash downrdquo dysfunction
                                      • ldquoBottom - uprdquo dysfunction
                                      • Slide 7
                                      • Whatrsquos the kidrsquos deal
                                      • Overview
                                      • This Dense Pudding
                                      • Sensory Processing Disorder
                                      • Slide 12
                                      • Slide 13
                                      • Developmental considerations
                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                      • Whatrsquos the kidrsquos deal (2)
                                      • Slide 17
                                      • Whatrsquos the kidrsquos deal (3)
                                      • Slide 19
                                      • Strategies
                                      • Regulatory-Sensory Processing Disorders
                                      • Slide 22
                                      • Slide 23
                                      • Regulatory-Sensory Processing Disorders (2)
                                      • Slide 25
                                      • Central Auditory Processing Disorder
                                      • Slide 27
                                      • Slide 28
                                      • Slide 29
                                      • Central Auditory Processing Disorder (2)
                                      • Central Auditory Processing Disorder (3)
                                      • Central Auditory Processing Disorder (4)
                                      • CAPD or ADHD
                                      • Whatrsquos the kidrsquos deal (4)
                                      • Slide 35
                                      • Strategies (2)
                                      • (C)APD
                                      • Treatment for CAPD
                                      • Treatment for CAPD (2)
                                      • Self-assessment
                                      • Attention Deficit Hyperactivity Disorder
                                      • Slide 42
                                      • Attention Deficit Hyperactivity Disorder (2)
                                      • (85 ndash X) x 365
                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                      • Core symptoms
                                      • Core symptoms (2)
                                      • hellipand the rest of the criteria
                                      • Slide 49
                                      • Functional impact of core symptoms
                                      • Functional impact of core symptoms (2)
                                      • Functional impact of core symptoms (3)
                                      • Slide 53
                                      • Functional impact of core symptoms (4)
                                      • Functional impact of core symptoms (5)
                                      • Functional impact of core symptoms (6)
                                      • Functional impact of core symptoms (7)
                                      • Functional impact of core symptoms (8)
                                      • Functional impact of core symptoms (9)
                                      • Subtypes of ADHD
                                      • Subtypes of ADHD (2)
                                      • Common comorbidities with ADHD
                                      • Slide 63
                                      • Common comorbidities with ADHD (2)
                                      • ADHD and girls
                                      • Slide 66
                                      • Slide 67
                                      • ADHD and women
                                      • Slide 69
                                      • ADHD and women (2)
                                      • Executive Functioning An Overarching Theme
                                      • The Executive Functions
                                      • The Executive Functions (2)
                                      • Slide 74
                                      • Slide 75
                                      • Appropriate expectations
                                      • Age-appropriate expectations
                                      • Age-appropriate expectations (2)
                                      • Age-appropriate expectations (3)
                                      • Age-appropriate expectations (4)
                                      • Age-appropriate expectations (5)
                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                      • Slide 84
                                      • Slide 85
                                      • Strategies (3)
                                      • Pharmacotherapy
                                      • Behavioral Supports
                                      • Slide 89
                                      • Slide 90
                                      • Slide 91
                                      • Slide 92
                                      • Slide 93
                                      • Slide 94
                                      • Slide 95
                                      • Slide 96
                                      • Slide 97
                                      • Slide 98
                                      • Slide 99
                                      • Slide 100
                                      • Slide 101
                                      • Slide 102
                                      • Slide 103
                                      • Slide 104
                                      • Slide 105
                                      • Slide 106
                                      • Slide 107
                                      • Slide 108
                                      • Slide 109
                                      • Slide 110
                                      • Time Out
                                      • Token economy
                                      • Slide 113
                                      • Slide 114
                                      • Slide 115
                                      • Intrinsic motivation
                                      • Slide 117
                                      • Slide 118
                                      • Slide 119
                                      • Metacognition
                                      • ldquoLend Me Your Brainrdquo
                                      • What Does Dopamine Feel Like
                                      • Preferred States What Does Dopamine Feel Like
                                      • Slide 124
                                      • PREFERRED STATES INVENTORY
                                      • PREFERRED STATES INVENTORY (2)
                                      • PREFERRED STATES INVENTORY (3)
                                      • Slide 128
                                      • Slide 129
                                      • Broaden and Build
                                      • ldquoNeuroMalleabilityrdquo
                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                      • The reward-and-planning system
                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                      • The reward-and-planning system (2)
                                      • Ways the reward-and-planning system can go wrong
                                      • Ways the reward-and-planning system can go wrong (2)
                                      • Ways the reward-and-planning system can go wrong (3)
                                      • Ways the reward-and-planning system can go wrong (4)
                                      • Slide 141
                                      • Lend Me Your Brain
                                      • Ways the reward-and-planning system can go wrong (5)
                                      • Ways the reward-and-planning system can go wrong (6)
                                      • Ways the reward-and-planning system can go wrong (7)
                                      • Slide 146
                                      • Ways the reward-and-planning system can go wrong (8)
                                      • Ways the reward-and-planning system can go wrong (9)
                                      • Slide 149
                                      • Ways the reward-and-planning system can go wrong (10)
                                      • Ways the reward-and-planning system can go wrong (11)
                                      • Slide 152
                                      • Ways the reward-and-planning system can go wrong (12)
                                      • Slide 154
                                      • Ways the reward-and-planning system can go wrong (13)
                                      • Ways the reward-and-planning system can go wrong (14)
                                      • Slide 157
                                      • Slide 158
                                      • Slide 159
                                      • Ways the reward-and-planning system can go wrong (15)
                                      • Ways the reward-and-planning system can go wrong (16)
                                      • Slide 162
                                      • Ways the reward-and-planning system can go wrong (17)
                                      • Slide 164
                                      • Instant gratification vs executive gratification
                                      • Slide 166
                                      • Slide 167
                                      • Slide 168
                                      • Slide 169
                                      • Slide 170
                                      • Self-Talk Proficiency
                                      • Self-Talk Proficiency (2)
                                      • Self-Talk Proficiency (3)
                                      • Self-Talk Proficiency (4)
                                      • Match the Picture
                                      • Slide 176
                                      • Slide 177
                                      • Distraction Delay Training
                                      • Slide 179
                                      • Slide 180
                                      • Executive Estimates Training
                                      • Learning Time
                                      • Learning Time (2)
                                      • Learning Time (3)
                                      • Slide 185
                                      • Slide 186
                                      • Learning Time (4)
                                      • Asking two questionshellip
                                      • Slide 189
                                      • Slide 190
                                      • Key Features of Video Games
                                      • Key Features of Video Games (2)
                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                      • Slide 194
                                      • Slide 195
                                      • Slide 196
                                      • Slide 197
                                      • Slide 198
                                      • Slide 199
                                      • Slide 200
                                      • Slide 201
                                      • Quarterly QI review
                                      • The post-mortem
                                      • Slide 204
                                      • Slide 205
                                      • Slide 206
                                      • Slide 207
                                      • Slide 208
                                      • Slide 209
                                      • Slide 210
                                      • The ldquoBig Fiverdquo
                                      • Slide 212
                                      • Slide 213
                                      • The ldquoBig Fiverdquo (2)
                                      • Slide 215
                                      • Slide 216
                                      • Slide 217
                                      • The ldquoBig Fiverdquo (3)
                                      • The ldquoBig Fiverdquo (4)
                                      • The ldquoBig Fiverdquo (5)
                                      • A challengehellip
                                      • Slide 222

                                        Central Auditory Processing Disorder

                                        CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors sound localization and lateralization auditory discrimination auditory pattern recognition

                                        Central Auditory Processing Disorder

                                        - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                                        Central Auditory Processing Disorder

                                        - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                                        CAPD or ADHD

                                        Whatrsquos the kidrsquos deal

                                        Strategies

                                        (C)APD

                                        Treatment ldquotop downrdquo ldquobottom uprdquo

                                        X

                                        Treatment for CAPD

                                        Environmental modifications

                                        Treatment for CAPD

                                        Compensatory Strategies

                                        Self-assessment

                                        >

                                        Attention Deficit Hyperactivity Disorder

                                        Increase salience

                                        Attention Deficit Hyperactivity Disorder

                                        (85 ndash X) x 365

                                        ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                        Core symptoms

                                        Inattention distractibility

                                        Core symptoms

                                        Hyperactivity impulsivity

                                        hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                        mental disorder

                                        Functional impact of core symptoms

                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                        Functional impact of core symptoms

                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                        Functional impact of core symptoms

                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                        Functional impact of core symptoms

                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                        Functional impact of core symptoms

                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                        Functional impact of core symptoms

                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                        Functional impact of core symptoms

                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                        Functional impact of core symptoms

                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                        Functional impact of core symptoms

                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                        Subtypes of ADHD

                                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                        Subtypes of ADHD

                                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                        Specifed

                                        Common comorbidities with ADHD

                                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                        processing challenges

                                        Common comorbidities with ADHD

                                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                        processing challenges

                                        ADHD and girls

                                        ADHD and women

                                        ADHD and women

                                        More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                        partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                        disorganization

                                        Executive FunctioningAn Overarching Theme

                                        Sensory Processing Disorder Central Auditory Processing

                                        Disorder ADHD and Executive Dysfunction

                                        The Executive Functions

                                        Internalizing speech Previewing

                                        Prioritizing Tempo control Inhibition

                                        The Executive Functions

                                        Determining salience (whatrsquos in it for me)

                                        Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                        Appropriate expectations

                                        Age-appropriate expectations

                                        Preschool 1-step errands Chores with cues Basic inhibition

                                        Age-appropriate expectations

                                        K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                        3rd ndash 5th

                                        Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                        Age-appropriate expectations

                                        6th ndash 8th

                                        complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                        Age-appropriate expectations

                                        Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                        already made Take othersrsquo perspective

                                        Age-appropriate expectations

                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                        Inter-connectedness of systems Cortico-striatal system for example

                                        Strategies

                                        Pharmacotherapy

                                        X

                                        Behavioral Supports

                                        A B C

                                        A B C

                                        behavior

                                        A B C

                                        consequences

                                        A B C

                                        antecedent

                                        A B C

                                        A B C

                                        antecedent

                                        A B C

                                        antecedent

                                        easy hard

                                        A B C

                                        consequences

                                        R P

                                        +

                                        -

                                        R+ P+

                                        R- P-

                                        Time Out

                                        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                        Token economy

                                        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                        Intrinsic motivation

                                        A B C

                                        consequencesX

                                        A B C

                                        behavior

                                        Metacognition

                                        Metacognitive knowledge Metacognitive strategies

                                        ldquoLend Me Your Brainrdquo

                                        What Does Dopamine Feel Like

                                        The Physiology of Motivation and Reward

                                        Preferred States What Does Dopamine Feel Like

                                        1 Great experience2 Kodak moment3 The feeeeling

                                        David D Nowell PhD189 May Street

                                        Worcester Mass 01602DrNowellcom

                                        PREFERRED STATES INVENTORY

                                        wwwLulucom

                                        Identify 20 peak experiences For each peak experience identify the

                                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                        of that moment Name it Check the 20 peak moment-feelings for

                                        clusters groupings There will probably be 4 or 5

                                        PREFERRED STATES INVENTORY

                                        Find a word a label for each of the groupings

                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                        ldquovaluesrdquo ways that you really like to feel

                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                        PREFERRED STATES INVENTORY

                                        PREFERRED STATES INVENTORY

                                        Broaden and Build

                                        ldquoNeuroMalleabilityrdquo

                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                        The reward-and-planning system

                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                        The reward-and-planning system

                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                        Ways the reward-and-planning system can go wrong

                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                        Ways the reward-and-planning system can go wrong

                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                        Ways the reward-and-planning system can go wrong

                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                        Ways the reward-and-planning system can go wrong

                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                        Lend Me Your Brain

                                        Supporting Clients with Executive Dysfunction

                                        Ways the reward-and-planning system can go wrong

                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                        Ways the reward-and-planning system can go wrong

                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                        Ways the reward-and-planning system can go wrong

                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                        Ways the reward-and-planning system can go wrong

                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                        Too busy with current activity

                                        Field dependent

                                        Ways the reward-and-planning system can go wrong

                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                        Ways the reward-and-planning system can go wrong

                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                        Ways the reward-and-planning system can go wrong

                                        Sequence problem-solve

                                        Ways the reward-and-planning system can go wrong

                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                        Ways the reward-and-planning system can go wrong

                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                        Ways the reward-and-planning system can go wrong

                                        Block out distractions

                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                        - E Goldberg

                                        Ways the reward-and-planning system can go wrong

                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                        Ways the reward-and-planning system can go wrong

                                        Get the reward

                                        Ways the reward-and-planning system can go wrong

                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                        Instant gratification vs

                                        executive gratification

                                        A B C

                                        behaviorx

                                        Self-Talk Proficiency

                                        Self-Talk Proficiency

                                        bull -ldquoHow are you going to know when to be readyrdquo

                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                        takerdquordquo

                                        Self-Talk Proficiency

                                        bull -ldquoHow are you going to know what you needrdquo

                                        bull -ldquoHow are you going to know what is most importantrdquo

                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                        bull -ldquoHow will you know when you are donerdquo

                                        Self-Talk Proficiency

                                        bull -ldquoHow will you continue when you are tiredrdquo

                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                        differentlyrdquo ldquoWho will be the first person to notice

                                        thathelliprdquo

                                        Match the Picture

                                        Distraction Delay Training

                                        Executive Estimates Training

                                        X

                                        Learning Time

                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                        Learning Time

                                        Learning Time

                                        Learning Time

                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                        Asking two questionshellip

                                        Am I having fun now And is this what I set out to do

                                        Am I having fun nowIs

                                        this

                                        what

                                        I se

                                        t out

                                        to

                                        do

                                        bullYesbullYes

                                        bullNobullYes

                                        bullYesbullNo

                                        bullNobullNo

                                        Am I having fun nowIs

                                        this

                                        what

                                        I se

                                        t out

                                        to

                                        do

                                        bullFunbullOn-task

                                        bullNot funbullOn-task

                                        bullFunbullNot on-task

                                        bullNot funbullNot on-task

                                        Key Features of Video Games

                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                        inappropriate behavior ndash never reverse this

                                        Key Features of Video Games

                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                        Volkow et al 2004

                                        Increase salience

                                        Increase salience

                                        Quarterly QI review

                                        The post-mortem

                                        Your 1 Organizational Tool

                                        Your 1 Organizational Tool

                                        Yoga read

                                        Staff meeting

                                        Planningsession

                                        Phone calls

                                        billing

                                        Your 1 Organizational Tool

                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                        Your 1 Organizational Tool

                                        Learn French

                                        Stop smoking

                                        Be a better spouse

                                        The ldquoBig Fiverdquo

                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                        The ldquoBig Fiverdquo

                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                        The ldquoBig Fiverdquo

                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                        The ldquoBig Fiverdquo

                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                        The ldquoBig Fiverdquo

                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                        A CHALLENGEhellip

                                        wwwDrNowellcom

                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                        DavidNowellSeminars

                                        DavidNowell

                                        • Slide 1
                                        • hellipa challenge
                                        • Slide 3
                                        • Perspective of this workshophellip
                                        • ldquoTop ndash downrdquo dysfunction
                                        • ldquoBottom - uprdquo dysfunction
                                        • Slide 7
                                        • Whatrsquos the kidrsquos deal
                                        • Overview
                                        • This Dense Pudding
                                        • Sensory Processing Disorder
                                        • Slide 12
                                        • Slide 13
                                        • Developmental considerations
                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                        • Whatrsquos the kidrsquos deal (2)
                                        • Slide 17
                                        • Whatrsquos the kidrsquos deal (3)
                                        • Slide 19
                                        • Strategies
                                        • Regulatory-Sensory Processing Disorders
                                        • Slide 22
                                        • Slide 23
                                        • Regulatory-Sensory Processing Disorders (2)
                                        • Slide 25
                                        • Central Auditory Processing Disorder
                                        • Slide 27
                                        • Slide 28
                                        • Slide 29
                                        • Central Auditory Processing Disorder (2)
                                        • Central Auditory Processing Disorder (3)
                                        • Central Auditory Processing Disorder (4)
                                        • CAPD or ADHD
                                        • Whatrsquos the kidrsquos deal (4)
                                        • Slide 35
                                        • Strategies (2)
                                        • (C)APD
                                        • Treatment for CAPD
                                        • Treatment for CAPD (2)
                                        • Self-assessment
                                        • Attention Deficit Hyperactivity Disorder
                                        • Slide 42
                                        • Attention Deficit Hyperactivity Disorder (2)
                                        • (85 ndash X) x 365
                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                        • Core symptoms
                                        • Core symptoms (2)
                                        • hellipand the rest of the criteria
                                        • Slide 49
                                        • Functional impact of core symptoms
                                        • Functional impact of core symptoms (2)
                                        • Functional impact of core symptoms (3)
                                        • Slide 53
                                        • Functional impact of core symptoms (4)
                                        • Functional impact of core symptoms (5)
                                        • Functional impact of core symptoms (6)
                                        • Functional impact of core symptoms (7)
                                        • Functional impact of core symptoms (8)
                                        • Functional impact of core symptoms (9)
                                        • Subtypes of ADHD
                                        • Subtypes of ADHD (2)
                                        • Common comorbidities with ADHD
                                        • Slide 63
                                        • Common comorbidities with ADHD (2)
                                        • ADHD and girls
                                        • Slide 66
                                        • Slide 67
                                        • ADHD and women
                                        • Slide 69
                                        • ADHD and women (2)
                                        • Executive Functioning An Overarching Theme
                                        • The Executive Functions
                                        • The Executive Functions (2)
                                        • Slide 74
                                        • Slide 75
                                        • Appropriate expectations
                                        • Age-appropriate expectations
                                        • Age-appropriate expectations (2)
                                        • Age-appropriate expectations (3)
                                        • Age-appropriate expectations (4)
                                        • Age-appropriate expectations (5)
                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                        • Slide 84
                                        • Slide 85
                                        • Strategies (3)
                                        • Pharmacotherapy
                                        • Behavioral Supports
                                        • Slide 89
                                        • Slide 90
                                        • Slide 91
                                        • Slide 92
                                        • Slide 93
                                        • Slide 94
                                        • Slide 95
                                        • Slide 96
                                        • Slide 97
                                        • Slide 98
                                        • Slide 99
                                        • Slide 100
                                        • Slide 101
                                        • Slide 102
                                        • Slide 103
                                        • Slide 104
                                        • Slide 105
                                        • Slide 106
                                        • Slide 107
                                        • Slide 108
                                        • Slide 109
                                        • Slide 110
                                        • Time Out
                                        • Token economy
                                        • Slide 113
                                        • Slide 114
                                        • Slide 115
                                        • Intrinsic motivation
                                        • Slide 117
                                        • Slide 118
                                        • Slide 119
                                        • Metacognition
                                        • ldquoLend Me Your Brainrdquo
                                        • What Does Dopamine Feel Like
                                        • Preferred States What Does Dopamine Feel Like
                                        • Slide 124
                                        • PREFERRED STATES INVENTORY
                                        • PREFERRED STATES INVENTORY (2)
                                        • PREFERRED STATES INVENTORY (3)
                                        • Slide 128
                                        • Slide 129
                                        • Broaden and Build
                                        • ldquoNeuroMalleabilityrdquo
                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                        • The reward-and-planning system
                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                        • The reward-and-planning system (2)
                                        • Ways the reward-and-planning system can go wrong
                                        • Ways the reward-and-planning system can go wrong (2)
                                        • Ways the reward-and-planning system can go wrong (3)
                                        • Ways the reward-and-planning system can go wrong (4)
                                        • Slide 141
                                        • Lend Me Your Brain
                                        • Ways the reward-and-planning system can go wrong (5)
                                        • Ways the reward-and-planning system can go wrong (6)
                                        • Ways the reward-and-planning system can go wrong (7)
                                        • Slide 146
                                        • Ways the reward-and-planning system can go wrong (8)
                                        • Ways the reward-and-planning system can go wrong (9)
                                        • Slide 149
                                        • Ways the reward-and-planning system can go wrong (10)
                                        • Ways the reward-and-planning system can go wrong (11)
                                        • Slide 152
                                        • Ways the reward-and-planning system can go wrong (12)
                                        • Slide 154
                                        • Ways the reward-and-planning system can go wrong (13)
                                        • Ways the reward-and-planning system can go wrong (14)
                                        • Slide 157
                                        • Slide 158
                                        • Slide 159
                                        • Ways the reward-and-planning system can go wrong (15)
                                        • Ways the reward-and-planning system can go wrong (16)
                                        • Slide 162
                                        • Ways the reward-and-planning system can go wrong (17)
                                        • Slide 164
                                        • Instant gratification vs executive gratification
                                        • Slide 166
                                        • Slide 167
                                        • Slide 168
                                        • Slide 169
                                        • Slide 170
                                        • Self-Talk Proficiency
                                        • Self-Talk Proficiency (2)
                                        • Self-Talk Proficiency (3)
                                        • Self-Talk Proficiency (4)
                                        • Match the Picture
                                        • Slide 176
                                        • Slide 177
                                        • Distraction Delay Training
                                        • Slide 179
                                        • Slide 180
                                        • Executive Estimates Training
                                        • Learning Time
                                        • Learning Time (2)
                                        • Learning Time (3)
                                        • Slide 185
                                        • Slide 186
                                        • Learning Time (4)
                                        • Asking two questionshellip
                                        • Slide 189
                                        • Slide 190
                                        • Key Features of Video Games
                                        • Key Features of Video Games (2)
                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                        • Slide 194
                                        • Slide 195
                                        • Slide 196
                                        • Slide 197
                                        • Slide 198
                                        • Slide 199
                                        • Slide 200
                                        • Slide 201
                                        • Quarterly QI review
                                        • The post-mortem
                                        • Slide 204
                                        • Slide 205
                                        • Slide 206
                                        • Slide 207
                                        • Slide 208
                                        • Slide 209
                                        • Slide 210
                                        • The ldquoBig Fiverdquo
                                        • Slide 212
                                        • Slide 213
                                        • The ldquoBig Fiverdquo (2)
                                        • Slide 215
                                        • Slide 216
                                        • Slide 217
                                        • The ldquoBig Fiverdquo (3)
                                        • The ldquoBig Fiverdquo (4)
                                        • The ldquoBig Fiverdquo (5)
                                        • A challengehellip
                                        • Slide 222

                                          Central Auditory Processing Disorder

                                          - Poor communicator (terse telegraphic) - Memorizes poorly- Hears better when watching the speaker - Problems with rapid speech - Interprets words too literally

                                          Central Auditory Processing Disorder

                                          - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                                          CAPD or ADHD

                                          Whatrsquos the kidrsquos deal

                                          Strategies

                                          (C)APD

                                          Treatment ldquotop downrdquo ldquobottom uprdquo

                                          X

                                          Treatment for CAPD

                                          Environmental modifications

                                          Treatment for CAPD

                                          Compensatory Strategies

                                          Self-assessment

                                          >

                                          Attention Deficit Hyperactivity Disorder

                                          Increase salience

                                          Attention Deficit Hyperactivity Disorder

                                          (85 ndash X) x 365

                                          ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                          Core symptoms

                                          Inattention distractibility

                                          Core symptoms

                                          Hyperactivity impulsivity

                                          hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                          mental disorder

                                          Functional impact of core symptoms

                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                          Functional impact of core symptoms

                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                          Functional impact of core symptoms

                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                          Functional impact of core symptoms

                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                          Functional impact of core symptoms

                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                          Functional impact of core symptoms

                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                          Functional impact of core symptoms

                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                          Functional impact of core symptoms

                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                          Functional impact of core symptoms

                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                          Subtypes of ADHD

                                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                          Subtypes of ADHD

                                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                          Specifed

                                          Common comorbidities with ADHD

                                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                          processing challenges

                                          Common comorbidities with ADHD

                                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                          processing challenges

                                          ADHD and girls

                                          ADHD and women

                                          ADHD and women

                                          More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                          partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                          disorganization

                                          Executive FunctioningAn Overarching Theme

                                          Sensory Processing Disorder Central Auditory Processing

                                          Disorder ADHD and Executive Dysfunction

                                          The Executive Functions

                                          Internalizing speech Previewing

                                          Prioritizing Tempo control Inhibition

                                          The Executive Functions

                                          Determining salience (whatrsquos in it for me)

                                          Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                          Appropriate expectations

                                          Age-appropriate expectations

                                          Preschool 1-step errands Chores with cues Basic inhibition

                                          Age-appropriate expectations

                                          K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                          3rd ndash 5th

                                          Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                          Age-appropriate expectations

                                          6th ndash 8th

                                          complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                          Age-appropriate expectations

                                          Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                          already made Take othersrsquo perspective

                                          Age-appropriate expectations

                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                          Inter-connectedness of systems Cortico-striatal system for example

                                          Strategies

                                          Pharmacotherapy

                                          X

                                          Behavioral Supports

                                          A B C

                                          A B C

                                          behavior

                                          A B C

                                          consequences

                                          A B C

                                          antecedent

                                          A B C

                                          A B C

                                          antecedent

                                          A B C

                                          antecedent

                                          easy hard

                                          A B C

                                          consequences

                                          R P

                                          +

                                          -

                                          R+ P+

                                          R- P-

                                          Time Out

                                          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                          Token economy

                                          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                          Intrinsic motivation

                                          A B C

                                          consequencesX

                                          A B C

                                          behavior

                                          Metacognition

                                          Metacognitive knowledge Metacognitive strategies

                                          ldquoLend Me Your Brainrdquo

                                          What Does Dopamine Feel Like

                                          The Physiology of Motivation and Reward

                                          Preferred States What Does Dopamine Feel Like

                                          1 Great experience2 Kodak moment3 The feeeeling

                                          David D Nowell PhD189 May Street

                                          Worcester Mass 01602DrNowellcom

                                          PREFERRED STATES INVENTORY

                                          wwwLulucom

                                          Identify 20 peak experiences For each peak experience identify the

                                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                          of that moment Name it Check the 20 peak moment-feelings for

                                          clusters groupings There will probably be 4 or 5

                                          PREFERRED STATES INVENTORY

                                          Find a word a label for each of the groupings

                                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                          ldquovaluesrdquo ways that you really like to feel

                                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                          PREFERRED STATES INVENTORY

                                          PREFERRED STATES INVENTORY

                                          Broaden and Build

                                          ldquoNeuroMalleabilityrdquo

                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                          The reward-and-planning system

                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                          The reward-and-planning system

                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                          Ways the reward-and-planning system can go wrong

                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                          Ways the reward-and-planning system can go wrong

                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                          Ways the reward-and-planning system can go wrong

                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                          Ways the reward-and-planning system can go wrong

                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                          Lend Me Your Brain

                                          Supporting Clients with Executive Dysfunction

                                          Ways the reward-and-planning system can go wrong

                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                          Ways the reward-and-planning system can go wrong

                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                          Ways the reward-and-planning system can go wrong

                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                          Ways the reward-and-planning system can go wrong

                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                          Too busy with current activity

                                          Field dependent

                                          Ways the reward-and-planning system can go wrong

                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                          Ways the reward-and-planning system can go wrong

                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                          Ways the reward-and-planning system can go wrong

                                          Sequence problem-solve

                                          Ways the reward-and-planning system can go wrong

                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                          Ways the reward-and-planning system can go wrong

                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                          Ways the reward-and-planning system can go wrong

                                          Block out distractions

                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                          - E Goldberg

                                          Ways the reward-and-planning system can go wrong

                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                          Ways the reward-and-planning system can go wrong

                                          Get the reward

                                          Ways the reward-and-planning system can go wrong

                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                          Instant gratification vs

                                          executive gratification

                                          A B C

                                          behaviorx

                                          Self-Talk Proficiency

                                          Self-Talk Proficiency

                                          bull -ldquoHow are you going to know when to be readyrdquo

                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                          takerdquordquo

                                          Self-Talk Proficiency

                                          bull -ldquoHow are you going to know what you needrdquo

                                          bull -ldquoHow are you going to know what is most importantrdquo

                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                          bull -ldquoHow will you know when you are donerdquo

                                          Self-Talk Proficiency

                                          bull -ldquoHow will you continue when you are tiredrdquo

                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                          differentlyrdquo ldquoWho will be the first person to notice

                                          thathelliprdquo

                                          Match the Picture

                                          Distraction Delay Training

                                          Executive Estimates Training

                                          X

                                          Learning Time

                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                          Learning Time

                                          Learning Time

                                          Learning Time

                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                          Asking two questionshellip

                                          Am I having fun now And is this what I set out to do

                                          Am I having fun nowIs

                                          this

                                          what

                                          I se

                                          t out

                                          to

                                          do

                                          bullYesbullYes

                                          bullNobullYes

                                          bullYesbullNo

                                          bullNobullNo

                                          Am I having fun nowIs

                                          this

                                          what

                                          I se

                                          t out

                                          to

                                          do

                                          bullFunbullOn-task

                                          bullNot funbullOn-task

                                          bullFunbullNot on-task

                                          bullNot funbullNot on-task

                                          Key Features of Video Games

                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                          inappropriate behavior ndash never reverse this

                                          Key Features of Video Games

                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                          Volkow et al 2004

                                          Increase salience

                                          Increase salience

                                          Quarterly QI review

                                          The post-mortem

                                          Your 1 Organizational Tool

                                          Your 1 Organizational Tool

                                          Yoga read

                                          Staff meeting

                                          Planningsession

                                          Phone calls

                                          billing

                                          Your 1 Organizational Tool

                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                          Your 1 Organizational Tool

                                          Learn French

                                          Stop smoking

                                          Be a better spouse

                                          The ldquoBig Fiverdquo

                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                          The ldquoBig Fiverdquo

                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                          The ldquoBig Fiverdquo

                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                          The ldquoBig Fiverdquo

                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                          The ldquoBig Fiverdquo

                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                          A CHALLENGEhellip

                                          wwwDrNowellcom

                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                          DavidNowellSeminars

                                          DavidNowell

                                          • Slide 1
                                          • hellipa challenge
                                          • Slide 3
                                          • Perspective of this workshophellip
                                          • ldquoTop ndash downrdquo dysfunction
                                          • ldquoBottom - uprdquo dysfunction
                                          • Slide 7
                                          • Whatrsquos the kidrsquos deal
                                          • Overview
                                          • This Dense Pudding
                                          • Sensory Processing Disorder
                                          • Slide 12
                                          • Slide 13
                                          • Developmental considerations
                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                          • Whatrsquos the kidrsquos deal (2)
                                          • Slide 17
                                          • Whatrsquos the kidrsquos deal (3)
                                          • Slide 19
                                          • Strategies
                                          • Regulatory-Sensory Processing Disorders
                                          • Slide 22
                                          • Slide 23
                                          • Regulatory-Sensory Processing Disorders (2)
                                          • Slide 25
                                          • Central Auditory Processing Disorder
                                          • Slide 27
                                          • Slide 28
                                          • Slide 29
                                          • Central Auditory Processing Disorder (2)
                                          • Central Auditory Processing Disorder (3)
                                          • Central Auditory Processing Disorder (4)
                                          • CAPD or ADHD
                                          • Whatrsquos the kidrsquos deal (4)
                                          • Slide 35
                                          • Strategies (2)
                                          • (C)APD
                                          • Treatment for CAPD
                                          • Treatment for CAPD (2)
                                          • Self-assessment
                                          • Attention Deficit Hyperactivity Disorder
                                          • Slide 42
                                          • Attention Deficit Hyperactivity Disorder (2)
                                          • (85 ndash X) x 365
                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                          • Core symptoms
                                          • Core symptoms (2)
                                          • hellipand the rest of the criteria
                                          • Slide 49
                                          • Functional impact of core symptoms
                                          • Functional impact of core symptoms (2)
                                          • Functional impact of core symptoms (3)
                                          • Slide 53
                                          • Functional impact of core symptoms (4)
                                          • Functional impact of core symptoms (5)
                                          • Functional impact of core symptoms (6)
                                          • Functional impact of core symptoms (7)
                                          • Functional impact of core symptoms (8)
                                          • Functional impact of core symptoms (9)
                                          • Subtypes of ADHD
                                          • Subtypes of ADHD (2)
                                          • Common comorbidities with ADHD
                                          • Slide 63
                                          • Common comorbidities with ADHD (2)
                                          • ADHD and girls
                                          • Slide 66
                                          • Slide 67
                                          • ADHD and women
                                          • Slide 69
                                          • ADHD and women (2)
                                          • Executive Functioning An Overarching Theme
                                          • The Executive Functions
                                          • The Executive Functions (2)
                                          • Slide 74
                                          • Slide 75
                                          • Appropriate expectations
                                          • Age-appropriate expectations
                                          • Age-appropriate expectations (2)
                                          • Age-appropriate expectations (3)
                                          • Age-appropriate expectations (4)
                                          • Age-appropriate expectations (5)
                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                          • Slide 84
                                          • Slide 85
                                          • Strategies (3)
                                          • Pharmacotherapy
                                          • Behavioral Supports
                                          • Slide 89
                                          • Slide 90
                                          • Slide 91
                                          • Slide 92
                                          • Slide 93
                                          • Slide 94
                                          • Slide 95
                                          • Slide 96
                                          • Slide 97
                                          • Slide 98
                                          • Slide 99
                                          • Slide 100
                                          • Slide 101
                                          • Slide 102
                                          • Slide 103
                                          • Slide 104
                                          • Slide 105
                                          • Slide 106
                                          • Slide 107
                                          • Slide 108
                                          • Slide 109
                                          • Slide 110
                                          • Time Out
                                          • Token economy
                                          • Slide 113
                                          • Slide 114
                                          • Slide 115
                                          • Intrinsic motivation
                                          • Slide 117
                                          • Slide 118
                                          • Slide 119
                                          • Metacognition
                                          • ldquoLend Me Your Brainrdquo
                                          • What Does Dopamine Feel Like
                                          • Preferred States What Does Dopamine Feel Like
                                          • Slide 124
                                          • PREFERRED STATES INVENTORY
                                          • PREFERRED STATES INVENTORY (2)
                                          • PREFERRED STATES INVENTORY (3)
                                          • Slide 128
                                          • Slide 129
                                          • Broaden and Build
                                          • ldquoNeuroMalleabilityrdquo
                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                          • The reward-and-planning system
                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                          • The reward-and-planning system (2)
                                          • Ways the reward-and-planning system can go wrong
                                          • Ways the reward-and-planning system can go wrong (2)
                                          • Ways the reward-and-planning system can go wrong (3)
                                          • Ways the reward-and-planning system can go wrong (4)
                                          • Slide 141
                                          • Lend Me Your Brain
                                          • Ways the reward-and-planning system can go wrong (5)
                                          • Ways the reward-and-planning system can go wrong (6)
                                          • Ways the reward-and-planning system can go wrong (7)
                                          • Slide 146
                                          • Ways the reward-and-planning system can go wrong (8)
                                          • Ways the reward-and-planning system can go wrong (9)
                                          • Slide 149
                                          • Ways the reward-and-planning system can go wrong (10)
                                          • Ways the reward-and-planning system can go wrong (11)
                                          • Slide 152
                                          • Ways the reward-and-planning system can go wrong (12)
                                          • Slide 154
                                          • Ways the reward-and-planning system can go wrong (13)
                                          • Ways the reward-and-planning system can go wrong (14)
                                          • Slide 157
                                          • Slide 158
                                          • Slide 159
                                          • Ways the reward-and-planning system can go wrong (15)
                                          • Ways the reward-and-planning system can go wrong (16)
                                          • Slide 162
                                          • Ways the reward-and-planning system can go wrong (17)
                                          • Slide 164
                                          • Instant gratification vs executive gratification
                                          • Slide 166
                                          • Slide 167
                                          • Slide 168
                                          • Slide 169
                                          • Slide 170
                                          • Self-Talk Proficiency
                                          • Self-Talk Proficiency (2)
                                          • Self-Talk Proficiency (3)
                                          • Self-Talk Proficiency (4)
                                          • Match the Picture
                                          • Slide 176
                                          • Slide 177
                                          • Distraction Delay Training
                                          • Slide 179
                                          • Slide 180
                                          • Executive Estimates Training
                                          • Learning Time
                                          • Learning Time (2)
                                          • Learning Time (3)
                                          • Slide 185
                                          • Slide 186
                                          • Learning Time (4)
                                          • Asking two questionshellip
                                          • Slide 189
                                          • Slide 190
                                          • Key Features of Video Games
                                          • Key Features of Video Games (2)
                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                          • Slide 194
                                          • Slide 195
                                          • Slide 196
                                          • Slide 197
                                          • Slide 198
                                          • Slide 199
                                          • Slide 200
                                          • Slide 201
                                          • Quarterly QI review
                                          • The post-mortem
                                          • Slide 204
                                          • Slide 205
                                          • Slide 206
                                          • Slide 207
                                          • Slide 208
                                          • Slide 209
                                          • Slide 210
                                          • The ldquoBig Fiverdquo
                                          • Slide 212
                                          • Slide 213
                                          • The ldquoBig Fiverdquo (2)
                                          • Slide 215
                                          • Slide 216
                                          • Slide 217
                                          • The ldquoBig Fiverdquo (3)
                                          • The ldquoBig Fiverdquo (4)
                                          • The ldquoBig Fiverdquo (5)
                                          • A challengehellip
                                          • Slide 222

                                            Central Auditory Processing Disorder

                                            - Often needs remarks repeated - Difficulty sounding out words- Confuses similar-sounding words- Difficulty following directions in a series - Speech developed late or unclearly

                                            CAPD or ADHD

                                            Whatrsquos the kidrsquos deal

                                            Strategies

                                            (C)APD

                                            Treatment ldquotop downrdquo ldquobottom uprdquo

                                            X

                                            Treatment for CAPD

                                            Environmental modifications

                                            Treatment for CAPD

                                            Compensatory Strategies

                                            Self-assessment

                                            >

                                            Attention Deficit Hyperactivity Disorder

                                            Increase salience

                                            Attention Deficit Hyperactivity Disorder

                                            (85 ndash X) x 365

                                            ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                            Core symptoms

                                            Inattention distractibility

                                            Core symptoms

                                            Hyperactivity impulsivity

                                            hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                            mental disorder

                                            Functional impact of core symptoms

                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                            Functional impact of core symptoms

                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                            Functional impact of core symptoms

                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                            Functional impact of core symptoms

                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                            Functional impact of core symptoms

                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                            Functional impact of core symptoms

                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                            Functional impact of core symptoms

                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                            Functional impact of core symptoms

                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                            Functional impact of core symptoms

                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                            Subtypes of ADHD

                                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                            Subtypes of ADHD

                                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                            Specifed

                                            Common comorbidities with ADHD

                                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                            processing challenges

                                            Common comorbidities with ADHD

                                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                            processing challenges

                                            ADHD and girls

                                            ADHD and women

                                            ADHD and women

                                            More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                            partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                            disorganization

                                            Executive FunctioningAn Overarching Theme

                                            Sensory Processing Disorder Central Auditory Processing

                                            Disorder ADHD and Executive Dysfunction

                                            The Executive Functions

                                            Internalizing speech Previewing

                                            Prioritizing Tempo control Inhibition

                                            The Executive Functions

                                            Determining salience (whatrsquos in it for me)

                                            Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                            Appropriate expectations

                                            Age-appropriate expectations

                                            Preschool 1-step errands Chores with cues Basic inhibition

                                            Age-appropriate expectations

                                            K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                            3rd ndash 5th

                                            Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                            Age-appropriate expectations

                                            6th ndash 8th

                                            complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                            Age-appropriate expectations

                                            Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                            already made Take othersrsquo perspective

                                            Age-appropriate expectations

                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                            Inter-connectedness of systems Cortico-striatal system for example

                                            Strategies

                                            Pharmacotherapy

                                            X

                                            Behavioral Supports

                                            A B C

                                            A B C

                                            behavior

                                            A B C

                                            consequences

                                            A B C

                                            antecedent

                                            A B C

                                            A B C

                                            antecedent

                                            A B C

                                            antecedent

                                            easy hard

                                            A B C

                                            consequences

                                            R P

                                            +

                                            -

                                            R+ P+

                                            R- P-

                                            Time Out

                                            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                            Token economy

                                            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                            Intrinsic motivation

                                            A B C

                                            consequencesX

                                            A B C

                                            behavior

                                            Metacognition

                                            Metacognitive knowledge Metacognitive strategies

                                            ldquoLend Me Your Brainrdquo

                                            What Does Dopamine Feel Like

                                            The Physiology of Motivation and Reward

                                            Preferred States What Does Dopamine Feel Like

                                            1 Great experience2 Kodak moment3 The feeeeling

                                            David D Nowell PhD189 May Street

                                            Worcester Mass 01602DrNowellcom

                                            PREFERRED STATES INVENTORY

                                            wwwLulucom

                                            Identify 20 peak experiences For each peak experience identify the

                                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                            of that moment Name it Check the 20 peak moment-feelings for

                                            clusters groupings There will probably be 4 or 5

                                            PREFERRED STATES INVENTORY

                                            Find a word a label for each of the groupings

                                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                            ldquovaluesrdquo ways that you really like to feel

                                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                            PREFERRED STATES INVENTORY

                                            PREFERRED STATES INVENTORY

                                            Broaden and Build

                                            ldquoNeuroMalleabilityrdquo

                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                            The reward-and-planning system

                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                            The reward-and-planning system

                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                            Ways the reward-and-planning system can go wrong

                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                            Ways the reward-and-planning system can go wrong

                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                            Ways the reward-and-planning system can go wrong

                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                            Ways the reward-and-planning system can go wrong

                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                            Lend Me Your Brain

                                            Supporting Clients with Executive Dysfunction

                                            Ways the reward-and-planning system can go wrong

                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                            Ways the reward-and-planning system can go wrong

                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                            Ways the reward-and-planning system can go wrong

                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                            Ways the reward-and-planning system can go wrong

                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                            Too busy with current activity

                                            Field dependent

                                            Ways the reward-and-planning system can go wrong

                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                            Ways the reward-and-planning system can go wrong

                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                            Ways the reward-and-planning system can go wrong

                                            Sequence problem-solve

                                            Ways the reward-and-planning system can go wrong

                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                            Ways the reward-and-planning system can go wrong

                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                            Ways the reward-and-planning system can go wrong

                                            Block out distractions

                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                            - E Goldberg

                                            Ways the reward-and-planning system can go wrong

                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                            Ways the reward-and-planning system can go wrong

                                            Get the reward

                                            Ways the reward-and-planning system can go wrong

                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                            Instant gratification vs

                                            executive gratification

                                            A B C

                                            behaviorx

                                            Self-Talk Proficiency

                                            Self-Talk Proficiency

                                            bull -ldquoHow are you going to know when to be readyrdquo

                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                            takerdquordquo

                                            Self-Talk Proficiency

                                            bull -ldquoHow are you going to know what you needrdquo

                                            bull -ldquoHow are you going to know what is most importantrdquo

                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                            bull -ldquoHow will you know when you are donerdquo

                                            Self-Talk Proficiency

                                            bull -ldquoHow will you continue when you are tiredrdquo

                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                            differentlyrdquo ldquoWho will be the first person to notice

                                            thathelliprdquo

                                            Match the Picture

                                            Distraction Delay Training

                                            Executive Estimates Training

                                            X

                                            Learning Time

                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                            Learning Time

                                            Learning Time

                                            Learning Time

                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                            Asking two questionshellip

                                            Am I having fun now And is this what I set out to do

                                            Am I having fun nowIs

                                            this

                                            what

                                            I se

                                            t out

                                            to

                                            do

                                            bullYesbullYes

                                            bullNobullYes

                                            bullYesbullNo

                                            bullNobullNo

                                            Am I having fun nowIs

                                            this

                                            what

                                            I se

                                            t out

                                            to

                                            do

                                            bullFunbullOn-task

                                            bullNot funbullOn-task

                                            bullFunbullNot on-task

                                            bullNot funbullNot on-task

                                            Key Features of Video Games

                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                            inappropriate behavior ndash never reverse this

                                            Key Features of Video Games

                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                            Volkow et al 2004

                                            Increase salience

                                            Increase salience

                                            Quarterly QI review

                                            The post-mortem

                                            Your 1 Organizational Tool

                                            Your 1 Organizational Tool

                                            Yoga read

                                            Staff meeting

                                            Planningsession

                                            Phone calls

                                            billing

                                            Your 1 Organizational Tool

                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                            Your 1 Organizational Tool

                                            Learn French

                                            Stop smoking

                                            Be a better spouse

                                            The ldquoBig Fiverdquo

                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                            The ldquoBig Fiverdquo

                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                            The ldquoBig Fiverdquo

                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                            The ldquoBig Fiverdquo

                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                            The ldquoBig Fiverdquo

                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                            A CHALLENGEhellip

                                            wwwDrNowellcom

                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                            DavidNowellSeminars

                                            DavidNowell

                                            • Slide 1
                                            • hellipa challenge
                                            • Slide 3
                                            • Perspective of this workshophellip
                                            • ldquoTop ndash downrdquo dysfunction
                                            • ldquoBottom - uprdquo dysfunction
                                            • Slide 7
                                            • Whatrsquos the kidrsquos deal
                                            • Overview
                                            • This Dense Pudding
                                            • Sensory Processing Disorder
                                            • Slide 12
                                            • Slide 13
                                            • Developmental considerations
                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                            • Whatrsquos the kidrsquos deal (2)
                                            • Slide 17
                                            • Whatrsquos the kidrsquos deal (3)
                                            • Slide 19
                                            • Strategies
                                            • Regulatory-Sensory Processing Disorders
                                            • Slide 22
                                            • Slide 23
                                            • Regulatory-Sensory Processing Disorders (2)
                                            • Slide 25
                                            • Central Auditory Processing Disorder
                                            • Slide 27
                                            • Slide 28
                                            • Slide 29
                                            • Central Auditory Processing Disorder (2)
                                            • Central Auditory Processing Disorder (3)
                                            • Central Auditory Processing Disorder (4)
                                            • CAPD or ADHD
                                            • Whatrsquos the kidrsquos deal (4)
                                            • Slide 35
                                            • Strategies (2)
                                            • (C)APD
                                            • Treatment for CAPD
                                            • Treatment for CAPD (2)
                                            • Self-assessment
                                            • Attention Deficit Hyperactivity Disorder
                                            • Slide 42
                                            • Attention Deficit Hyperactivity Disorder (2)
                                            • (85 ndash X) x 365
                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                            • Core symptoms
                                            • Core symptoms (2)
                                            • hellipand the rest of the criteria
                                            • Slide 49
                                            • Functional impact of core symptoms
                                            • Functional impact of core symptoms (2)
                                            • Functional impact of core symptoms (3)
                                            • Slide 53
                                            • Functional impact of core symptoms (4)
                                            • Functional impact of core symptoms (5)
                                            • Functional impact of core symptoms (6)
                                            • Functional impact of core symptoms (7)
                                            • Functional impact of core symptoms (8)
                                            • Functional impact of core symptoms (9)
                                            • Subtypes of ADHD
                                            • Subtypes of ADHD (2)
                                            • Common comorbidities with ADHD
                                            • Slide 63
                                            • Common comorbidities with ADHD (2)
                                            • ADHD and girls
                                            • Slide 66
                                            • Slide 67
                                            • ADHD and women
                                            • Slide 69
                                            • ADHD and women (2)
                                            • Executive Functioning An Overarching Theme
                                            • The Executive Functions
                                            • The Executive Functions (2)
                                            • Slide 74
                                            • Slide 75
                                            • Appropriate expectations
                                            • Age-appropriate expectations
                                            • Age-appropriate expectations (2)
                                            • Age-appropriate expectations (3)
                                            • Age-appropriate expectations (4)
                                            • Age-appropriate expectations (5)
                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                            • Slide 84
                                            • Slide 85
                                            • Strategies (3)
                                            • Pharmacotherapy
                                            • Behavioral Supports
                                            • Slide 89
                                            • Slide 90
                                            • Slide 91
                                            • Slide 92
                                            • Slide 93
                                            • Slide 94
                                            • Slide 95
                                            • Slide 96
                                            • Slide 97
                                            • Slide 98
                                            • Slide 99
                                            • Slide 100
                                            • Slide 101
                                            • Slide 102
                                            • Slide 103
                                            • Slide 104
                                            • Slide 105
                                            • Slide 106
                                            • Slide 107
                                            • Slide 108
                                            • Slide 109
                                            • Slide 110
                                            • Time Out
                                            • Token economy
                                            • Slide 113
                                            • Slide 114
                                            • Slide 115
                                            • Intrinsic motivation
                                            • Slide 117
                                            • Slide 118
                                            • Slide 119
                                            • Metacognition
                                            • ldquoLend Me Your Brainrdquo
                                            • What Does Dopamine Feel Like
                                            • Preferred States What Does Dopamine Feel Like
                                            • Slide 124
                                            • PREFERRED STATES INVENTORY
                                            • PREFERRED STATES INVENTORY (2)
                                            • PREFERRED STATES INVENTORY (3)
                                            • Slide 128
                                            • Slide 129
                                            • Broaden and Build
                                            • ldquoNeuroMalleabilityrdquo
                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                            • The reward-and-planning system
                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                            • The reward-and-planning system (2)
                                            • Ways the reward-and-planning system can go wrong
                                            • Ways the reward-and-planning system can go wrong (2)
                                            • Ways the reward-and-planning system can go wrong (3)
                                            • Ways the reward-and-planning system can go wrong (4)
                                            • Slide 141
                                            • Lend Me Your Brain
                                            • Ways the reward-and-planning system can go wrong (5)
                                            • Ways the reward-and-planning system can go wrong (6)
                                            • Ways the reward-and-planning system can go wrong (7)
                                            • Slide 146
                                            • Ways the reward-and-planning system can go wrong (8)
                                            • Ways the reward-and-planning system can go wrong (9)
                                            • Slide 149
                                            • Ways the reward-and-planning system can go wrong (10)
                                            • Ways the reward-and-planning system can go wrong (11)
                                            • Slide 152
                                            • Ways the reward-and-planning system can go wrong (12)
                                            • Slide 154
                                            • Ways the reward-and-planning system can go wrong (13)
                                            • Ways the reward-and-planning system can go wrong (14)
                                            • Slide 157
                                            • Slide 158
                                            • Slide 159
                                            • Ways the reward-and-planning system can go wrong (15)
                                            • Ways the reward-and-planning system can go wrong (16)
                                            • Slide 162
                                            • Ways the reward-and-planning system can go wrong (17)
                                            • Slide 164
                                            • Instant gratification vs executive gratification
                                            • Slide 166
                                            • Slide 167
                                            • Slide 168
                                            • Slide 169
                                            • Slide 170
                                            • Self-Talk Proficiency
                                            • Self-Talk Proficiency (2)
                                            • Self-Talk Proficiency (3)
                                            • Self-Talk Proficiency (4)
                                            • Match the Picture
                                            • Slide 176
                                            • Slide 177
                                            • Distraction Delay Training
                                            • Slide 179
                                            • Slide 180
                                            • Executive Estimates Training
                                            • Learning Time
                                            • Learning Time (2)
                                            • Learning Time (3)
                                            • Slide 185
                                            • Slide 186
                                            • Learning Time (4)
                                            • Asking two questionshellip
                                            • Slide 189
                                            • Slide 190
                                            • Key Features of Video Games
                                            • Key Features of Video Games (2)
                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                            • Slide 194
                                            • Slide 195
                                            • Slide 196
                                            • Slide 197
                                            • Slide 198
                                            • Slide 199
                                            • Slide 200
                                            • Slide 201
                                            • Quarterly QI review
                                            • The post-mortem
                                            • Slide 204
                                            • Slide 205
                                            • Slide 206
                                            • Slide 207
                                            • Slide 208
                                            • Slide 209
                                            • Slide 210
                                            • The ldquoBig Fiverdquo
                                            • Slide 212
                                            • Slide 213
                                            • The ldquoBig Fiverdquo (2)
                                            • Slide 215
                                            • Slide 216
                                            • Slide 217
                                            • The ldquoBig Fiverdquo (3)
                                            • The ldquoBig Fiverdquo (4)
                                            • The ldquoBig Fiverdquo (5)
                                            • A challengehellip
                                            • Slide 222

                                              CAPD or ADHD

                                              Whatrsquos the kidrsquos deal

                                              Strategies

                                              (C)APD

                                              Treatment ldquotop downrdquo ldquobottom uprdquo

                                              X

                                              Treatment for CAPD

                                              Environmental modifications

                                              Treatment for CAPD

                                              Compensatory Strategies

                                              Self-assessment

                                              >

                                              Attention Deficit Hyperactivity Disorder

                                              Increase salience

                                              Attention Deficit Hyperactivity Disorder

                                              (85 ndash X) x 365

                                              ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                              Core symptoms

                                              Inattention distractibility

                                              Core symptoms

                                              Hyperactivity impulsivity

                                              hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                              mental disorder

                                              Functional impact of core symptoms

                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                              Functional impact of core symptoms

                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                              Functional impact of core symptoms

                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                              Functional impact of core symptoms

                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                              Functional impact of core symptoms

                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                              Functional impact of core symptoms

                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                              Functional impact of core symptoms

                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                              Functional impact of core symptoms

                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                              Functional impact of core symptoms

                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                              Subtypes of ADHD

                                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                              Subtypes of ADHD

                                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                              Specifed

                                              Common comorbidities with ADHD

                                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                              processing challenges

                                              Common comorbidities with ADHD

                                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                              processing challenges

                                              ADHD and girls

                                              ADHD and women

                                              ADHD and women

                                              More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                              partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                              disorganization

                                              Executive FunctioningAn Overarching Theme

                                              Sensory Processing Disorder Central Auditory Processing

                                              Disorder ADHD and Executive Dysfunction

                                              The Executive Functions

                                              Internalizing speech Previewing

                                              Prioritizing Tempo control Inhibition

                                              The Executive Functions

                                              Determining salience (whatrsquos in it for me)

                                              Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                              Appropriate expectations

                                              Age-appropriate expectations

                                              Preschool 1-step errands Chores with cues Basic inhibition

                                              Age-appropriate expectations

                                              K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                              3rd ndash 5th

                                              Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                              Age-appropriate expectations

                                              6th ndash 8th

                                              complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                              Age-appropriate expectations

                                              Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                              already made Take othersrsquo perspective

                                              Age-appropriate expectations

                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                              Inter-connectedness of systems Cortico-striatal system for example

                                              Strategies

                                              Pharmacotherapy

                                              X

                                              Behavioral Supports

                                              A B C

                                              A B C

                                              behavior

                                              A B C

                                              consequences

                                              A B C

                                              antecedent

                                              A B C

                                              A B C

                                              antecedent

                                              A B C

                                              antecedent

                                              easy hard

                                              A B C

                                              consequences

                                              R P

                                              +

                                              -

                                              R+ P+

                                              R- P-

                                              Time Out

                                              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                              Token economy

                                              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                              Intrinsic motivation

                                              A B C

                                              consequencesX

                                              A B C

                                              behavior

                                              Metacognition

                                              Metacognitive knowledge Metacognitive strategies

                                              ldquoLend Me Your Brainrdquo

                                              What Does Dopamine Feel Like

                                              The Physiology of Motivation and Reward

                                              Preferred States What Does Dopamine Feel Like

                                              1 Great experience2 Kodak moment3 The feeeeling

                                              David D Nowell PhD189 May Street

                                              Worcester Mass 01602DrNowellcom

                                              PREFERRED STATES INVENTORY

                                              wwwLulucom

                                              Identify 20 peak experiences For each peak experience identify the

                                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                              of that moment Name it Check the 20 peak moment-feelings for

                                              clusters groupings There will probably be 4 or 5

                                              PREFERRED STATES INVENTORY

                                              Find a word a label for each of the groupings

                                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                              ldquovaluesrdquo ways that you really like to feel

                                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                              PREFERRED STATES INVENTORY

                                              PREFERRED STATES INVENTORY

                                              Broaden and Build

                                              ldquoNeuroMalleabilityrdquo

                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                              The reward-and-planning system

                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                              The reward-and-planning system

                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                              Ways the reward-and-planning system can go wrong

                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                              Ways the reward-and-planning system can go wrong

                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                              Ways the reward-and-planning system can go wrong

                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                              Ways the reward-and-planning system can go wrong

                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                              Lend Me Your Brain

                                              Supporting Clients with Executive Dysfunction

                                              Ways the reward-and-planning system can go wrong

                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                              Ways the reward-and-planning system can go wrong

                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                              Ways the reward-and-planning system can go wrong

                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                              Ways the reward-and-planning system can go wrong

                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                              Too busy with current activity

                                              Field dependent

                                              Ways the reward-and-planning system can go wrong

                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                              Ways the reward-and-planning system can go wrong

                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                              Ways the reward-and-planning system can go wrong

                                              Sequence problem-solve

                                              Ways the reward-and-planning system can go wrong

                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                              Ways the reward-and-planning system can go wrong

                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                              Ways the reward-and-planning system can go wrong

                                              Block out distractions

                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                              - E Goldberg

                                              Ways the reward-and-planning system can go wrong

                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                              Ways the reward-and-planning system can go wrong

                                              Get the reward

                                              Ways the reward-and-planning system can go wrong

                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                              Instant gratification vs

                                              executive gratification

                                              A B C

                                              behaviorx

                                              Self-Talk Proficiency

                                              Self-Talk Proficiency

                                              bull -ldquoHow are you going to know when to be readyrdquo

                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                              takerdquordquo

                                              Self-Talk Proficiency

                                              bull -ldquoHow are you going to know what you needrdquo

                                              bull -ldquoHow are you going to know what is most importantrdquo

                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                              bull -ldquoHow will you know when you are donerdquo

                                              Self-Talk Proficiency

                                              bull -ldquoHow will you continue when you are tiredrdquo

                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                              differentlyrdquo ldquoWho will be the first person to notice

                                              thathelliprdquo

                                              Match the Picture

                                              Distraction Delay Training

                                              Executive Estimates Training

                                              X

                                              Learning Time

                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                              Learning Time

                                              Learning Time

                                              Learning Time

                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                              Asking two questionshellip

                                              Am I having fun now And is this what I set out to do

                                              Am I having fun nowIs

                                              this

                                              what

                                              I se

                                              t out

                                              to

                                              do

                                              bullYesbullYes

                                              bullNobullYes

                                              bullYesbullNo

                                              bullNobullNo

                                              Am I having fun nowIs

                                              this

                                              what

                                              I se

                                              t out

                                              to

                                              do

                                              bullFunbullOn-task

                                              bullNot funbullOn-task

                                              bullFunbullNot on-task

                                              bullNot funbullNot on-task

                                              Key Features of Video Games

                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                              inappropriate behavior ndash never reverse this

                                              Key Features of Video Games

                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                              Volkow et al 2004

                                              Increase salience

                                              Increase salience

                                              Quarterly QI review

                                              The post-mortem

                                              Your 1 Organizational Tool

                                              Your 1 Organizational Tool

                                              Yoga read

                                              Staff meeting

                                              Planningsession

                                              Phone calls

                                              billing

                                              Your 1 Organizational Tool

                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                              Your 1 Organizational Tool

                                              Learn French

                                              Stop smoking

                                              Be a better spouse

                                              The ldquoBig Fiverdquo

                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                              The ldquoBig Fiverdquo

                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                              The ldquoBig Fiverdquo

                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                              The ldquoBig Fiverdquo

                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                              The ldquoBig Fiverdquo

                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                              A CHALLENGEhellip

                                              wwwDrNowellcom

                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                              DavidNowellSeminars

                                              DavidNowell

                                              • Slide 1
                                              • hellipa challenge
                                              • Slide 3
                                              • Perspective of this workshophellip
                                              • ldquoTop ndash downrdquo dysfunction
                                              • ldquoBottom - uprdquo dysfunction
                                              • Slide 7
                                              • Whatrsquos the kidrsquos deal
                                              • Overview
                                              • This Dense Pudding
                                              • Sensory Processing Disorder
                                              • Slide 12
                                              • Slide 13
                                              • Developmental considerations
                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                              • Whatrsquos the kidrsquos deal (2)
                                              • Slide 17
                                              • Whatrsquos the kidrsquos deal (3)
                                              • Slide 19
                                              • Strategies
                                              • Regulatory-Sensory Processing Disorders
                                              • Slide 22
                                              • Slide 23
                                              • Regulatory-Sensory Processing Disorders (2)
                                              • Slide 25
                                              • Central Auditory Processing Disorder
                                              • Slide 27
                                              • Slide 28
                                              • Slide 29
                                              • Central Auditory Processing Disorder (2)
                                              • Central Auditory Processing Disorder (3)
                                              • Central Auditory Processing Disorder (4)
                                              • CAPD or ADHD
                                              • Whatrsquos the kidrsquos deal (4)
                                              • Slide 35
                                              • Strategies (2)
                                              • (C)APD
                                              • Treatment for CAPD
                                              • Treatment for CAPD (2)
                                              • Self-assessment
                                              • Attention Deficit Hyperactivity Disorder
                                              • Slide 42
                                              • Attention Deficit Hyperactivity Disorder (2)
                                              • (85 ndash X) x 365
                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                              • Core symptoms
                                              • Core symptoms (2)
                                              • hellipand the rest of the criteria
                                              • Slide 49
                                              • Functional impact of core symptoms
                                              • Functional impact of core symptoms (2)
                                              • Functional impact of core symptoms (3)
                                              • Slide 53
                                              • Functional impact of core symptoms (4)
                                              • Functional impact of core symptoms (5)
                                              • Functional impact of core symptoms (6)
                                              • Functional impact of core symptoms (7)
                                              • Functional impact of core symptoms (8)
                                              • Functional impact of core symptoms (9)
                                              • Subtypes of ADHD
                                              • Subtypes of ADHD (2)
                                              • Common comorbidities with ADHD
                                              • Slide 63
                                              • Common comorbidities with ADHD (2)
                                              • ADHD and girls
                                              • Slide 66
                                              • Slide 67
                                              • ADHD and women
                                              • Slide 69
                                              • ADHD and women (2)
                                              • Executive Functioning An Overarching Theme
                                              • The Executive Functions
                                              • The Executive Functions (2)
                                              • Slide 74
                                              • Slide 75
                                              • Appropriate expectations
                                              • Age-appropriate expectations
                                              • Age-appropriate expectations (2)
                                              • Age-appropriate expectations (3)
                                              • Age-appropriate expectations (4)
                                              • Age-appropriate expectations (5)
                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                              • Slide 84
                                              • Slide 85
                                              • Strategies (3)
                                              • Pharmacotherapy
                                              • Behavioral Supports
                                              • Slide 89
                                              • Slide 90
                                              • Slide 91
                                              • Slide 92
                                              • Slide 93
                                              • Slide 94
                                              • Slide 95
                                              • Slide 96
                                              • Slide 97
                                              • Slide 98
                                              • Slide 99
                                              • Slide 100
                                              • Slide 101
                                              • Slide 102
                                              • Slide 103
                                              • Slide 104
                                              • Slide 105
                                              • Slide 106
                                              • Slide 107
                                              • Slide 108
                                              • Slide 109
                                              • Slide 110
                                              • Time Out
                                              • Token economy
                                              • Slide 113
                                              • Slide 114
                                              • Slide 115
                                              • Intrinsic motivation
                                              • Slide 117
                                              • Slide 118
                                              • Slide 119
                                              • Metacognition
                                              • ldquoLend Me Your Brainrdquo
                                              • What Does Dopamine Feel Like
                                              • Preferred States What Does Dopamine Feel Like
                                              • Slide 124
                                              • PREFERRED STATES INVENTORY
                                              • PREFERRED STATES INVENTORY (2)
                                              • PREFERRED STATES INVENTORY (3)
                                              • Slide 128
                                              • Slide 129
                                              • Broaden and Build
                                              • ldquoNeuroMalleabilityrdquo
                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                              • The reward-and-planning system
                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                              • The reward-and-planning system (2)
                                              • Ways the reward-and-planning system can go wrong
                                              • Ways the reward-and-planning system can go wrong (2)
                                              • Ways the reward-and-planning system can go wrong (3)
                                              • Ways the reward-and-planning system can go wrong (4)
                                              • Slide 141
                                              • Lend Me Your Brain
                                              • Ways the reward-and-planning system can go wrong (5)
                                              • Ways the reward-and-planning system can go wrong (6)
                                              • Ways the reward-and-planning system can go wrong (7)
                                              • Slide 146
                                              • Ways the reward-and-planning system can go wrong (8)
                                              • Ways the reward-and-planning system can go wrong (9)
                                              • Slide 149
                                              • Ways the reward-and-planning system can go wrong (10)
                                              • Ways the reward-and-planning system can go wrong (11)
                                              • Slide 152
                                              • Ways the reward-and-planning system can go wrong (12)
                                              • Slide 154
                                              • Ways the reward-and-planning system can go wrong (13)
                                              • Ways the reward-and-planning system can go wrong (14)
                                              • Slide 157
                                              • Slide 158
                                              • Slide 159
                                              • Ways the reward-and-planning system can go wrong (15)
                                              • Ways the reward-and-planning system can go wrong (16)
                                              • Slide 162
                                              • Ways the reward-and-planning system can go wrong (17)
                                              • Slide 164
                                              • Instant gratification vs executive gratification
                                              • Slide 166
                                              • Slide 167
                                              • Slide 168
                                              • Slide 169
                                              • Slide 170
                                              • Self-Talk Proficiency
                                              • Self-Talk Proficiency (2)
                                              • Self-Talk Proficiency (3)
                                              • Self-Talk Proficiency (4)
                                              • Match the Picture
                                              • Slide 176
                                              • Slide 177
                                              • Distraction Delay Training
                                              • Slide 179
                                              • Slide 180
                                              • Executive Estimates Training
                                              • Learning Time
                                              • Learning Time (2)
                                              • Learning Time (3)
                                              • Slide 185
                                              • Slide 186
                                              • Learning Time (4)
                                              • Asking two questionshellip
                                              • Slide 189
                                              • Slide 190
                                              • Key Features of Video Games
                                              • Key Features of Video Games (2)
                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                              • Slide 194
                                              • Slide 195
                                              • Slide 196
                                              • Slide 197
                                              • Slide 198
                                              • Slide 199
                                              • Slide 200
                                              • Slide 201
                                              • Quarterly QI review
                                              • The post-mortem
                                              • Slide 204
                                              • Slide 205
                                              • Slide 206
                                              • Slide 207
                                              • Slide 208
                                              • Slide 209
                                              • Slide 210
                                              • The ldquoBig Fiverdquo
                                              • Slide 212
                                              • Slide 213
                                              • The ldquoBig Fiverdquo (2)
                                              • Slide 215
                                              • Slide 216
                                              • Slide 217
                                              • The ldquoBig Fiverdquo (3)
                                              • The ldquoBig Fiverdquo (4)
                                              • The ldquoBig Fiverdquo (5)
                                              • A challengehellip
                                              • Slide 222

                                                Whatrsquos the kidrsquos deal

                                                Strategies

                                                (C)APD

                                                Treatment ldquotop downrdquo ldquobottom uprdquo

                                                X

                                                Treatment for CAPD

                                                Environmental modifications

                                                Treatment for CAPD

                                                Compensatory Strategies

                                                Self-assessment

                                                >

                                                Attention Deficit Hyperactivity Disorder

                                                Increase salience

                                                Attention Deficit Hyperactivity Disorder

                                                (85 ndash X) x 365

                                                ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                Core symptoms

                                                Inattention distractibility

                                                Core symptoms

                                                Hyperactivity impulsivity

                                                hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                mental disorder

                                                Functional impact of core symptoms

                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                Functional impact of core symptoms

                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                Functional impact of core symptoms

                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                Functional impact of core symptoms

                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                Functional impact of core symptoms

                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                Functional impact of core symptoms

                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                Functional impact of core symptoms

                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                Functional impact of core symptoms

                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                Functional impact of core symptoms

                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                Subtypes of ADHD

                                                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                Subtypes of ADHD

                                                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                Specifed

                                                Common comorbidities with ADHD

                                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                processing challenges

                                                Common comorbidities with ADHD

                                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                processing challenges

                                                ADHD and girls

                                                ADHD and women

                                                ADHD and women

                                                More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                disorganization

                                                Executive FunctioningAn Overarching Theme

                                                Sensory Processing Disorder Central Auditory Processing

                                                Disorder ADHD and Executive Dysfunction

                                                The Executive Functions

                                                Internalizing speech Previewing

                                                Prioritizing Tempo control Inhibition

                                                The Executive Functions

                                                Determining salience (whatrsquos in it for me)

                                                Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                Appropriate expectations

                                                Age-appropriate expectations

                                                Preschool 1-step errands Chores with cues Basic inhibition

                                                Age-appropriate expectations

                                                K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                3rd ndash 5th

                                                Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                Age-appropriate expectations

                                                6th ndash 8th

                                                complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                Age-appropriate expectations

                                                Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                already made Take othersrsquo perspective

                                                Age-appropriate expectations

                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                Inter-connectedness of systems Cortico-striatal system for example

                                                Strategies

                                                Pharmacotherapy

                                                X

                                                Behavioral Supports

                                                A B C

                                                A B C

                                                behavior

                                                A B C

                                                consequences

                                                A B C

                                                antecedent

                                                A B C

                                                A B C

                                                antecedent

                                                A B C

                                                antecedent

                                                easy hard

                                                A B C

                                                consequences

                                                R P

                                                +

                                                -

                                                R+ P+

                                                R- P-

                                                Time Out

                                                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                Token economy

                                                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                Intrinsic motivation

                                                A B C

                                                consequencesX

                                                A B C

                                                behavior

                                                Metacognition

                                                Metacognitive knowledge Metacognitive strategies

                                                ldquoLend Me Your Brainrdquo

                                                What Does Dopamine Feel Like

                                                The Physiology of Motivation and Reward

                                                Preferred States What Does Dopamine Feel Like

                                                1 Great experience2 Kodak moment3 The feeeeling

                                                David D Nowell PhD189 May Street

                                                Worcester Mass 01602DrNowellcom

                                                PREFERRED STATES INVENTORY

                                                wwwLulucom

                                                Identify 20 peak experiences For each peak experience identify the

                                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                of that moment Name it Check the 20 peak moment-feelings for

                                                clusters groupings There will probably be 4 or 5

                                                PREFERRED STATES INVENTORY

                                                Find a word a label for each of the groupings

                                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                ldquovaluesrdquo ways that you really like to feel

                                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                PREFERRED STATES INVENTORY

                                                PREFERRED STATES INVENTORY

                                                Broaden and Build

                                                ldquoNeuroMalleabilityrdquo

                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                The reward-and-planning system

                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                The reward-and-planning system

                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                Ways the reward-and-planning system can go wrong

                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                Ways the reward-and-planning system can go wrong

                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                Ways the reward-and-planning system can go wrong

                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                Ways the reward-and-planning system can go wrong

                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                Lend Me Your Brain

                                                Supporting Clients with Executive Dysfunction

                                                Ways the reward-and-planning system can go wrong

                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                Ways the reward-and-planning system can go wrong

                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                Ways the reward-and-planning system can go wrong

                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                Ways the reward-and-planning system can go wrong

                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                Too busy with current activity

                                                Field dependent

                                                Ways the reward-and-planning system can go wrong

                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                Ways the reward-and-planning system can go wrong

                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                Ways the reward-and-planning system can go wrong

                                                Sequence problem-solve

                                                Ways the reward-and-planning system can go wrong

                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                Ways the reward-and-planning system can go wrong

                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                Ways the reward-and-planning system can go wrong

                                                Block out distractions

                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                - E Goldberg

                                                Ways the reward-and-planning system can go wrong

                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                Ways the reward-and-planning system can go wrong

                                                Get the reward

                                                Ways the reward-and-planning system can go wrong

                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                Instant gratification vs

                                                executive gratification

                                                A B C

                                                behaviorx

                                                Self-Talk Proficiency

                                                Self-Talk Proficiency

                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                takerdquordquo

                                                Self-Talk Proficiency

                                                bull -ldquoHow are you going to know what you needrdquo

                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                bull -ldquoHow will you know when you are donerdquo

                                                Self-Talk Proficiency

                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                differentlyrdquo ldquoWho will be the first person to notice

                                                thathelliprdquo

                                                Match the Picture

                                                Distraction Delay Training

                                                Executive Estimates Training

                                                X

                                                Learning Time

                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                Learning Time

                                                Learning Time

                                                Learning Time

                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                Asking two questionshellip

                                                Am I having fun now And is this what I set out to do

                                                Am I having fun nowIs

                                                this

                                                what

                                                I se

                                                t out

                                                to

                                                do

                                                bullYesbullYes

                                                bullNobullYes

                                                bullYesbullNo

                                                bullNobullNo

                                                Am I having fun nowIs

                                                this

                                                what

                                                I se

                                                t out

                                                to

                                                do

                                                bullFunbullOn-task

                                                bullNot funbullOn-task

                                                bullFunbullNot on-task

                                                bullNot funbullNot on-task

                                                Key Features of Video Games

                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                inappropriate behavior ndash never reverse this

                                                Key Features of Video Games

                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                Volkow et al 2004

                                                Increase salience

                                                Increase salience

                                                Quarterly QI review

                                                The post-mortem

                                                Your 1 Organizational Tool

                                                Your 1 Organizational Tool

                                                Yoga read

                                                Staff meeting

                                                Planningsession

                                                Phone calls

                                                billing

                                                Your 1 Organizational Tool

                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                Your 1 Organizational Tool

                                                Learn French

                                                Stop smoking

                                                Be a better spouse

                                                The ldquoBig Fiverdquo

                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                The ldquoBig Fiverdquo

                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                The ldquoBig Fiverdquo

                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                The ldquoBig Fiverdquo

                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                The ldquoBig Fiverdquo

                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                A CHALLENGEhellip

                                                wwwDrNowellcom

                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                DavidNowellSeminars

                                                DavidNowell

                                                • Slide 1
                                                • hellipa challenge
                                                • Slide 3
                                                • Perspective of this workshophellip
                                                • ldquoTop ndash downrdquo dysfunction
                                                • ldquoBottom - uprdquo dysfunction
                                                • Slide 7
                                                • Whatrsquos the kidrsquos deal
                                                • Overview
                                                • This Dense Pudding
                                                • Sensory Processing Disorder
                                                • Slide 12
                                                • Slide 13
                                                • Developmental considerations
                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                • Whatrsquos the kidrsquos deal (2)
                                                • Slide 17
                                                • Whatrsquos the kidrsquos deal (3)
                                                • Slide 19
                                                • Strategies
                                                • Regulatory-Sensory Processing Disorders
                                                • Slide 22
                                                • Slide 23
                                                • Regulatory-Sensory Processing Disorders (2)
                                                • Slide 25
                                                • Central Auditory Processing Disorder
                                                • Slide 27
                                                • Slide 28
                                                • Slide 29
                                                • Central Auditory Processing Disorder (2)
                                                • Central Auditory Processing Disorder (3)
                                                • Central Auditory Processing Disorder (4)
                                                • CAPD or ADHD
                                                • Whatrsquos the kidrsquos deal (4)
                                                • Slide 35
                                                • Strategies (2)
                                                • (C)APD
                                                • Treatment for CAPD
                                                • Treatment for CAPD (2)
                                                • Self-assessment
                                                • Attention Deficit Hyperactivity Disorder
                                                • Slide 42
                                                • Attention Deficit Hyperactivity Disorder (2)
                                                • (85 ndash X) x 365
                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                • Core symptoms
                                                • Core symptoms (2)
                                                • hellipand the rest of the criteria
                                                • Slide 49
                                                • Functional impact of core symptoms
                                                • Functional impact of core symptoms (2)
                                                • Functional impact of core symptoms (3)
                                                • Slide 53
                                                • Functional impact of core symptoms (4)
                                                • Functional impact of core symptoms (5)
                                                • Functional impact of core symptoms (6)
                                                • Functional impact of core symptoms (7)
                                                • Functional impact of core symptoms (8)
                                                • Functional impact of core symptoms (9)
                                                • Subtypes of ADHD
                                                • Subtypes of ADHD (2)
                                                • Common comorbidities with ADHD
                                                • Slide 63
                                                • Common comorbidities with ADHD (2)
                                                • ADHD and girls
                                                • Slide 66
                                                • Slide 67
                                                • ADHD and women
                                                • Slide 69
                                                • ADHD and women (2)
                                                • Executive Functioning An Overarching Theme
                                                • The Executive Functions
                                                • The Executive Functions (2)
                                                • Slide 74
                                                • Slide 75
                                                • Appropriate expectations
                                                • Age-appropriate expectations
                                                • Age-appropriate expectations (2)
                                                • Age-appropriate expectations (3)
                                                • Age-appropriate expectations (4)
                                                • Age-appropriate expectations (5)
                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                • Slide 84
                                                • Slide 85
                                                • Strategies (3)
                                                • Pharmacotherapy
                                                • Behavioral Supports
                                                • Slide 89
                                                • Slide 90
                                                • Slide 91
                                                • Slide 92
                                                • Slide 93
                                                • Slide 94
                                                • Slide 95
                                                • Slide 96
                                                • Slide 97
                                                • Slide 98
                                                • Slide 99
                                                • Slide 100
                                                • Slide 101
                                                • Slide 102
                                                • Slide 103
                                                • Slide 104
                                                • Slide 105
                                                • Slide 106
                                                • Slide 107
                                                • Slide 108
                                                • Slide 109
                                                • Slide 110
                                                • Time Out
                                                • Token economy
                                                • Slide 113
                                                • Slide 114
                                                • Slide 115
                                                • Intrinsic motivation
                                                • Slide 117
                                                • Slide 118
                                                • Slide 119
                                                • Metacognition
                                                • ldquoLend Me Your Brainrdquo
                                                • What Does Dopamine Feel Like
                                                • Preferred States What Does Dopamine Feel Like
                                                • Slide 124
                                                • PREFERRED STATES INVENTORY
                                                • PREFERRED STATES INVENTORY (2)
                                                • PREFERRED STATES INVENTORY (3)
                                                • Slide 128
                                                • Slide 129
                                                • Broaden and Build
                                                • ldquoNeuroMalleabilityrdquo
                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                • The reward-and-planning system
                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                • The reward-and-planning system (2)
                                                • Ways the reward-and-planning system can go wrong
                                                • Ways the reward-and-planning system can go wrong (2)
                                                • Ways the reward-and-planning system can go wrong (3)
                                                • Ways the reward-and-planning system can go wrong (4)
                                                • Slide 141
                                                • Lend Me Your Brain
                                                • Ways the reward-and-planning system can go wrong (5)
                                                • Ways the reward-and-planning system can go wrong (6)
                                                • Ways the reward-and-planning system can go wrong (7)
                                                • Slide 146
                                                • Ways the reward-and-planning system can go wrong (8)
                                                • Ways the reward-and-planning system can go wrong (9)
                                                • Slide 149
                                                • Ways the reward-and-planning system can go wrong (10)
                                                • Ways the reward-and-planning system can go wrong (11)
                                                • Slide 152
                                                • Ways the reward-and-planning system can go wrong (12)
                                                • Slide 154
                                                • Ways the reward-and-planning system can go wrong (13)
                                                • Ways the reward-and-planning system can go wrong (14)
                                                • Slide 157
                                                • Slide 158
                                                • Slide 159
                                                • Ways the reward-and-planning system can go wrong (15)
                                                • Ways the reward-and-planning system can go wrong (16)
                                                • Slide 162
                                                • Ways the reward-and-planning system can go wrong (17)
                                                • Slide 164
                                                • Instant gratification vs executive gratification
                                                • Slide 166
                                                • Slide 167
                                                • Slide 168
                                                • Slide 169
                                                • Slide 170
                                                • Self-Talk Proficiency
                                                • Self-Talk Proficiency (2)
                                                • Self-Talk Proficiency (3)
                                                • Self-Talk Proficiency (4)
                                                • Match the Picture
                                                • Slide 176
                                                • Slide 177
                                                • Distraction Delay Training
                                                • Slide 179
                                                • Slide 180
                                                • Executive Estimates Training
                                                • Learning Time
                                                • Learning Time (2)
                                                • Learning Time (3)
                                                • Slide 185
                                                • Slide 186
                                                • Learning Time (4)
                                                • Asking two questionshellip
                                                • Slide 189
                                                • Slide 190
                                                • Key Features of Video Games
                                                • Key Features of Video Games (2)
                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                • Slide 194
                                                • Slide 195
                                                • Slide 196
                                                • Slide 197
                                                • Slide 198
                                                • Slide 199
                                                • Slide 200
                                                • Slide 201
                                                • Quarterly QI review
                                                • The post-mortem
                                                • Slide 204
                                                • Slide 205
                                                • Slide 206
                                                • Slide 207
                                                • Slide 208
                                                • Slide 209
                                                • Slide 210
                                                • The ldquoBig Fiverdquo
                                                • Slide 212
                                                • Slide 213
                                                • The ldquoBig Fiverdquo (2)
                                                • Slide 215
                                                • Slide 216
                                                • Slide 217
                                                • The ldquoBig Fiverdquo (3)
                                                • The ldquoBig Fiverdquo (4)
                                                • The ldquoBig Fiverdquo (5)
                                                • A challengehellip
                                                • Slide 222

                                                  Strategies

                                                  (C)APD

                                                  Treatment ldquotop downrdquo ldquobottom uprdquo

                                                  X

                                                  Treatment for CAPD

                                                  Environmental modifications

                                                  Treatment for CAPD

                                                  Compensatory Strategies

                                                  Self-assessment

                                                  >

                                                  Attention Deficit Hyperactivity Disorder

                                                  Increase salience

                                                  Attention Deficit Hyperactivity Disorder

                                                  (85 ndash X) x 365

                                                  ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                  Core symptoms

                                                  Inattention distractibility

                                                  Core symptoms

                                                  Hyperactivity impulsivity

                                                  hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                  mental disorder

                                                  Functional impact of core symptoms

                                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                  Functional impact of core symptoms

                                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                  Functional impact of core symptoms

                                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                  Functional impact of core symptoms

                                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                  Functional impact of core symptoms

                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                  Functional impact of core symptoms

                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                  Functional impact of core symptoms

                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                  Functional impact of core symptoms

                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                  Functional impact of core symptoms

                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                  Subtypes of ADHD

                                                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                  Subtypes of ADHD

                                                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                  Specifed

                                                  Common comorbidities with ADHD

                                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                  processing challenges

                                                  Common comorbidities with ADHD

                                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                  processing challenges

                                                  ADHD and girls

                                                  ADHD and women

                                                  ADHD and women

                                                  More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                  partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                  disorganization

                                                  Executive FunctioningAn Overarching Theme

                                                  Sensory Processing Disorder Central Auditory Processing

                                                  Disorder ADHD and Executive Dysfunction

                                                  The Executive Functions

                                                  Internalizing speech Previewing

                                                  Prioritizing Tempo control Inhibition

                                                  The Executive Functions

                                                  Determining salience (whatrsquos in it for me)

                                                  Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                  Appropriate expectations

                                                  Age-appropriate expectations

                                                  Preschool 1-step errands Chores with cues Basic inhibition

                                                  Age-appropriate expectations

                                                  K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                  3rd ndash 5th

                                                  Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                  Age-appropriate expectations

                                                  6th ndash 8th

                                                  complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                  Age-appropriate expectations

                                                  Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                  already made Take othersrsquo perspective

                                                  Age-appropriate expectations

                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                  Inter-connectedness of systems Cortico-striatal system for example

                                                  Strategies

                                                  Pharmacotherapy

                                                  X

                                                  Behavioral Supports

                                                  A B C

                                                  A B C

                                                  behavior

                                                  A B C

                                                  consequences

                                                  A B C

                                                  antecedent

                                                  A B C

                                                  A B C

                                                  antecedent

                                                  A B C

                                                  antecedent

                                                  easy hard

                                                  A B C

                                                  consequences

                                                  R P

                                                  +

                                                  -

                                                  R+ P+

                                                  R- P-

                                                  Time Out

                                                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                  Token economy

                                                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                  Intrinsic motivation

                                                  A B C

                                                  consequencesX

                                                  A B C

                                                  behavior

                                                  Metacognition

                                                  Metacognitive knowledge Metacognitive strategies

                                                  ldquoLend Me Your Brainrdquo

                                                  What Does Dopamine Feel Like

                                                  The Physiology of Motivation and Reward

                                                  Preferred States What Does Dopamine Feel Like

                                                  1 Great experience2 Kodak moment3 The feeeeling

                                                  David D Nowell PhD189 May Street

                                                  Worcester Mass 01602DrNowellcom

                                                  PREFERRED STATES INVENTORY

                                                  wwwLulucom

                                                  Identify 20 peak experiences For each peak experience identify the

                                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                  of that moment Name it Check the 20 peak moment-feelings for

                                                  clusters groupings There will probably be 4 or 5

                                                  PREFERRED STATES INVENTORY

                                                  Find a word a label for each of the groupings

                                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                  ldquovaluesrdquo ways that you really like to feel

                                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                  PREFERRED STATES INVENTORY

                                                  PREFERRED STATES INVENTORY

                                                  Broaden and Build

                                                  ldquoNeuroMalleabilityrdquo

                                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                  The reward-and-planning system

                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                  The reward-and-planning system

                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                  Ways the reward-and-planning system can go wrong

                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                  Ways the reward-and-planning system can go wrong

                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                  Ways the reward-and-planning system can go wrong

                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                  Ways the reward-and-planning system can go wrong

                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                  Lend Me Your Brain

                                                  Supporting Clients with Executive Dysfunction

                                                  Ways the reward-and-planning system can go wrong

                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                  Ways the reward-and-planning system can go wrong

                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                  Ways the reward-and-planning system can go wrong

                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                  Ways the reward-and-planning system can go wrong

                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                  Too busy with current activity

                                                  Field dependent

                                                  Ways the reward-and-planning system can go wrong

                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                  Ways the reward-and-planning system can go wrong

                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                  Ways the reward-and-planning system can go wrong

                                                  Sequence problem-solve

                                                  Ways the reward-and-planning system can go wrong

                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                  Ways the reward-and-planning system can go wrong

                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                  Ways the reward-and-planning system can go wrong

                                                  Block out distractions

                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                  - E Goldberg

                                                  Ways the reward-and-planning system can go wrong

                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                  Ways the reward-and-planning system can go wrong

                                                  Get the reward

                                                  Ways the reward-and-planning system can go wrong

                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                  Instant gratification vs

                                                  executive gratification

                                                  A B C

                                                  behaviorx

                                                  Self-Talk Proficiency

                                                  Self-Talk Proficiency

                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                  takerdquordquo

                                                  Self-Talk Proficiency

                                                  bull -ldquoHow are you going to know what you needrdquo

                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                  bull -ldquoHow will you know when you are donerdquo

                                                  Self-Talk Proficiency

                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                  thathelliprdquo

                                                  Match the Picture

                                                  Distraction Delay Training

                                                  Executive Estimates Training

                                                  X

                                                  Learning Time

                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                  Learning Time

                                                  Learning Time

                                                  Learning Time

                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                  Asking two questionshellip

                                                  Am I having fun now And is this what I set out to do

                                                  Am I having fun nowIs

                                                  this

                                                  what

                                                  I se

                                                  t out

                                                  to

                                                  do

                                                  bullYesbullYes

                                                  bullNobullYes

                                                  bullYesbullNo

                                                  bullNobullNo

                                                  Am I having fun nowIs

                                                  this

                                                  what

                                                  I se

                                                  t out

                                                  to

                                                  do

                                                  bullFunbullOn-task

                                                  bullNot funbullOn-task

                                                  bullFunbullNot on-task

                                                  bullNot funbullNot on-task

                                                  Key Features of Video Games

                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                  inappropriate behavior ndash never reverse this

                                                  Key Features of Video Games

                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                  Volkow et al 2004

                                                  Increase salience

                                                  Increase salience

                                                  Quarterly QI review

                                                  The post-mortem

                                                  Your 1 Organizational Tool

                                                  Your 1 Organizational Tool

                                                  Yoga read

                                                  Staff meeting

                                                  Planningsession

                                                  Phone calls

                                                  billing

                                                  Your 1 Organizational Tool

                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                  Your 1 Organizational Tool

                                                  Learn French

                                                  Stop smoking

                                                  Be a better spouse

                                                  The ldquoBig Fiverdquo

                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                  The ldquoBig Fiverdquo

                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                  The ldquoBig Fiverdquo

                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                  The ldquoBig Fiverdquo

                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                  The ldquoBig Fiverdquo

                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                  A CHALLENGEhellip

                                                  wwwDrNowellcom

                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                  DavidNowellSeminars

                                                  DavidNowell

                                                  • Slide 1
                                                  • hellipa challenge
                                                  • Slide 3
                                                  • Perspective of this workshophellip
                                                  • ldquoTop ndash downrdquo dysfunction
                                                  • ldquoBottom - uprdquo dysfunction
                                                  • Slide 7
                                                  • Whatrsquos the kidrsquos deal
                                                  • Overview
                                                  • This Dense Pudding
                                                  • Sensory Processing Disorder
                                                  • Slide 12
                                                  • Slide 13
                                                  • Developmental considerations
                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                  • Whatrsquos the kidrsquos deal (2)
                                                  • Slide 17
                                                  • Whatrsquos the kidrsquos deal (3)
                                                  • Slide 19
                                                  • Strategies
                                                  • Regulatory-Sensory Processing Disorders
                                                  • Slide 22
                                                  • Slide 23
                                                  • Regulatory-Sensory Processing Disorders (2)
                                                  • Slide 25
                                                  • Central Auditory Processing Disorder
                                                  • Slide 27
                                                  • Slide 28
                                                  • Slide 29
                                                  • Central Auditory Processing Disorder (2)
                                                  • Central Auditory Processing Disorder (3)
                                                  • Central Auditory Processing Disorder (4)
                                                  • CAPD or ADHD
                                                  • Whatrsquos the kidrsquos deal (4)
                                                  • Slide 35
                                                  • Strategies (2)
                                                  • (C)APD
                                                  • Treatment for CAPD
                                                  • Treatment for CAPD (2)
                                                  • Self-assessment
                                                  • Attention Deficit Hyperactivity Disorder
                                                  • Slide 42
                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                  • (85 ndash X) x 365
                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                  • Core symptoms
                                                  • Core symptoms (2)
                                                  • hellipand the rest of the criteria
                                                  • Slide 49
                                                  • Functional impact of core symptoms
                                                  • Functional impact of core symptoms (2)
                                                  • Functional impact of core symptoms (3)
                                                  • Slide 53
                                                  • Functional impact of core symptoms (4)
                                                  • Functional impact of core symptoms (5)
                                                  • Functional impact of core symptoms (6)
                                                  • Functional impact of core symptoms (7)
                                                  • Functional impact of core symptoms (8)
                                                  • Functional impact of core symptoms (9)
                                                  • Subtypes of ADHD
                                                  • Subtypes of ADHD (2)
                                                  • Common comorbidities with ADHD
                                                  • Slide 63
                                                  • Common comorbidities with ADHD (2)
                                                  • ADHD and girls
                                                  • Slide 66
                                                  • Slide 67
                                                  • ADHD and women
                                                  • Slide 69
                                                  • ADHD and women (2)
                                                  • Executive Functioning An Overarching Theme
                                                  • The Executive Functions
                                                  • The Executive Functions (2)
                                                  • Slide 74
                                                  • Slide 75
                                                  • Appropriate expectations
                                                  • Age-appropriate expectations
                                                  • Age-appropriate expectations (2)
                                                  • Age-appropriate expectations (3)
                                                  • Age-appropriate expectations (4)
                                                  • Age-appropriate expectations (5)
                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                  • Slide 84
                                                  • Slide 85
                                                  • Strategies (3)
                                                  • Pharmacotherapy
                                                  • Behavioral Supports
                                                  • Slide 89
                                                  • Slide 90
                                                  • Slide 91
                                                  • Slide 92
                                                  • Slide 93
                                                  • Slide 94
                                                  • Slide 95
                                                  • Slide 96
                                                  • Slide 97
                                                  • Slide 98
                                                  • Slide 99
                                                  • Slide 100
                                                  • Slide 101
                                                  • Slide 102
                                                  • Slide 103
                                                  • Slide 104
                                                  • Slide 105
                                                  • Slide 106
                                                  • Slide 107
                                                  • Slide 108
                                                  • Slide 109
                                                  • Slide 110
                                                  • Time Out
                                                  • Token economy
                                                  • Slide 113
                                                  • Slide 114
                                                  • Slide 115
                                                  • Intrinsic motivation
                                                  • Slide 117
                                                  • Slide 118
                                                  • Slide 119
                                                  • Metacognition
                                                  • ldquoLend Me Your Brainrdquo
                                                  • What Does Dopamine Feel Like
                                                  • Preferred States What Does Dopamine Feel Like
                                                  • Slide 124
                                                  • PREFERRED STATES INVENTORY
                                                  • PREFERRED STATES INVENTORY (2)
                                                  • PREFERRED STATES INVENTORY (3)
                                                  • Slide 128
                                                  • Slide 129
                                                  • Broaden and Build
                                                  • ldquoNeuroMalleabilityrdquo
                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                  • The reward-and-planning system
                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                  • The reward-and-planning system (2)
                                                  • Ways the reward-and-planning system can go wrong
                                                  • Ways the reward-and-planning system can go wrong (2)
                                                  • Ways the reward-and-planning system can go wrong (3)
                                                  • Ways the reward-and-planning system can go wrong (4)
                                                  • Slide 141
                                                  • Lend Me Your Brain
                                                  • Ways the reward-and-planning system can go wrong (5)
                                                  • Ways the reward-and-planning system can go wrong (6)
                                                  • Ways the reward-and-planning system can go wrong (7)
                                                  • Slide 146
                                                  • Ways the reward-and-planning system can go wrong (8)
                                                  • Ways the reward-and-planning system can go wrong (9)
                                                  • Slide 149
                                                  • Ways the reward-and-planning system can go wrong (10)
                                                  • Ways the reward-and-planning system can go wrong (11)
                                                  • Slide 152
                                                  • Ways the reward-and-planning system can go wrong (12)
                                                  • Slide 154
                                                  • Ways the reward-and-planning system can go wrong (13)
                                                  • Ways the reward-and-planning system can go wrong (14)
                                                  • Slide 157
                                                  • Slide 158
                                                  • Slide 159
                                                  • Ways the reward-and-planning system can go wrong (15)
                                                  • Ways the reward-and-planning system can go wrong (16)
                                                  • Slide 162
                                                  • Ways the reward-and-planning system can go wrong (17)
                                                  • Slide 164
                                                  • Instant gratification vs executive gratification
                                                  • Slide 166
                                                  • Slide 167
                                                  • Slide 168
                                                  • Slide 169
                                                  • Slide 170
                                                  • Self-Talk Proficiency
                                                  • Self-Talk Proficiency (2)
                                                  • Self-Talk Proficiency (3)
                                                  • Self-Talk Proficiency (4)
                                                  • Match the Picture
                                                  • Slide 176
                                                  • Slide 177
                                                  • Distraction Delay Training
                                                  • Slide 179
                                                  • Slide 180
                                                  • Executive Estimates Training
                                                  • Learning Time
                                                  • Learning Time (2)
                                                  • Learning Time (3)
                                                  • Slide 185
                                                  • Slide 186
                                                  • Learning Time (4)
                                                  • Asking two questionshellip
                                                  • Slide 189
                                                  • Slide 190
                                                  • Key Features of Video Games
                                                  • Key Features of Video Games (2)
                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                  • Slide 194
                                                  • Slide 195
                                                  • Slide 196
                                                  • Slide 197
                                                  • Slide 198
                                                  • Slide 199
                                                  • Slide 200
                                                  • Slide 201
                                                  • Quarterly QI review
                                                  • The post-mortem
                                                  • Slide 204
                                                  • Slide 205
                                                  • Slide 206
                                                  • Slide 207
                                                  • Slide 208
                                                  • Slide 209
                                                  • Slide 210
                                                  • The ldquoBig Fiverdquo
                                                  • Slide 212
                                                  • Slide 213
                                                  • The ldquoBig Fiverdquo (2)
                                                  • Slide 215
                                                  • Slide 216
                                                  • Slide 217
                                                  • The ldquoBig Fiverdquo (3)
                                                  • The ldquoBig Fiverdquo (4)
                                                  • The ldquoBig Fiverdquo (5)
                                                  • A challengehellip
                                                  • Slide 222

                                                    (C)APD

                                                    Treatment ldquotop downrdquo ldquobottom uprdquo

                                                    X

                                                    Treatment for CAPD

                                                    Environmental modifications

                                                    Treatment for CAPD

                                                    Compensatory Strategies

                                                    Self-assessment

                                                    >

                                                    Attention Deficit Hyperactivity Disorder

                                                    Increase salience

                                                    Attention Deficit Hyperactivity Disorder

                                                    (85 ndash X) x 365

                                                    ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                    Core symptoms

                                                    Inattention distractibility

                                                    Core symptoms

                                                    Hyperactivity impulsivity

                                                    hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                    mental disorder

                                                    Functional impact of core symptoms

                                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                    Functional impact of core symptoms

                                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                    Functional impact of core symptoms

                                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                    Functional impact of core symptoms

                                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                    Functional impact of core symptoms

                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                    Functional impact of core symptoms

                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                    Functional impact of core symptoms

                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                    Functional impact of core symptoms

                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                    Functional impact of core symptoms

                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                    Subtypes of ADHD

                                                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                    Subtypes of ADHD

                                                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                    Specifed

                                                    Common comorbidities with ADHD

                                                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                    processing challenges

                                                    Common comorbidities with ADHD

                                                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                    processing challenges

                                                    ADHD and girls

                                                    ADHD and women

                                                    ADHD and women

                                                    More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                    partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                    disorganization

                                                    Executive FunctioningAn Overarching Theme

                                                    Sensory Processing Disorder Central Auditory Processing

                                                    Disorder ADHD and Executive Dysfunction

                                                    The Executive Functions

                                                    Internalizing speech Previewing

                                                    Prioritizing Tempo control Inhibition

                                                    The Executive Functions

                                                    Determining salience (whatrsquos in it for me)

                                                    Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                    Appropriate expectations

                                                    Age-appropriate expectations

                                                    Preschool 1-step errands Chores with cues Basic inhibition

                                                    Age-appropriate expectations

                                                    K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                    3rd ndash 5th

                                                    Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                    Age-appropriate expectations

                                                    6th ndash 8th

                                                    complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                    Age-appropriate expectations

                                                    Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                    already made Take othersrsquo perspective

                                                    Age-appropriate expectations

                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                    Inter-connectedness of systems Cortico-striatal system for example

                                                    Strategies

                                                    Pharmacotherapy

                                                    X

                                                    Behavioral Supports

                                                    A B C

                                                    A B C

                                                    behavior

                                                    A B C

                                                    consequences

                                                    A B C

                                                    antecedent

                                                    A B C

                                                    A B C

                                                    antecedent

                                                    A B C

                                                    antecedent

                                                    easy hard

                                                    A B C

                                                    consequences

                                                    R P

                                                    +

                                                    -

                                                    R+ P+

                                                    R- P-

                                                    Time Out

                                                    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                    Token economy

                                                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                    Intrinsic motivation

                                                    A B C

                                                    consequencesX

                                                    A B C

                                                    behavior

                                                    Metacognition

                                                    Metacognitive knowledge Metacognitive strategies

                                                    ldquoLend Me Your Brainrdquo

                                                    What Does Dopamine Feel Like

                                                    The Physiology of Motivation and Reward

                                                    Preferred States What Does Dopamine Feel Like

                                                    1 Great experience2 Kodak moment3 The feeeeling

                                                    David D Nowell PhD189 May Street

                                                    Worcester Mass 01602DrNowellcom

                                                    PREFERRED STATES INVENTORY

                                                    wwwLulucom

                                                    Identify 20 peak experiences For each peak experience identify the

                                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                    of that moment Name it Check the 20 peak moment-feelings for

                                                    clusters groupings There will probably be 4 or 5

                                                    PREFERRED STATES INVENTORY

                                                    Find a word a label for each of the groupings

                                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                    ldquovaluesrdquo ways that you really like to feel

                                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                    PREFERRED STATES INVENTORY

                                                    PREFERRED STATES INVENTORY

                                                    Broaden and Build

                                                    ldquoNeuroMalleabilityrdquo

                                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                    The reward-and-planning system

                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                    The reward-and-planning system

                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                    Ways the reward-and-planning system can go wrong

                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                    Ways the reward-and-planning system can go wrong

                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                    Ways the reward-and-planning system can go wrong

                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                    Ways the reward-and-planning system can go wrong

                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                    Lend Me Your Brain

                                                    Supporting Clients with Executive Dysfunction

                                                    Ways the reward-and-planning system can go wrong

                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                    Ways the reward-and-planning system can go wrong

                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                    Ways the reward-and-planning system can go wrong

                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                    Ways the reward-and-planning system can go wrong

                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                    Too busy with current activity

                                                    Field dependent

                                                    Ways the reward-and-planning system can go wrong

                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                    Ways the reward-and-planning system can go wrong

                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                    Ways the reward-and-planning system can go wrong

                                                    Sequence problem-solve

                                                    Ways the reward-and-planning system can go wrong

                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                    Ways the reward-and-planning system can go wrong

                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                    Ways the reward-and-planning system can go wrong

                                                    Block out distractions

                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                    - E Goldberg

                                                    Ways the reward-and-planning system can go wrong

                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                    Ways the reward-and-planning system can go wrong

                                                    Get the reward

                                                    Ways the reward-and-planning system can go wrong

                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                    Instant gratification vs

                                                    executive gratification

                                                    A B C

                                                    behaviorx

                                                    Self-Talk Proficiency

                                                    Self-Talk Proficiency

                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                    takerdquordquo

                                                    Self-Talk Proficiency

                                                    bull -ldquoHow are you going to know what you needrdquo

                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                    bull -ldquoHow will you know when you are donerdquo

                                                    Self-Talk Proficiency

                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                    thathelliprdquo

                                                    Match the Picture

                                                    Distraction Delay Training

                                                    Executive Estimates Training

                                                    X

                                                    Learning Time

                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                    Learning Time

                                                    Learning Time

                                                    Learning Time

                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                    Asking two questionshellip

                                                    Am I having fun now And is this what I set out to do

                                                    Am I having fun nowIs

                                                    this

                                                    what

                                                    I se

                                                    t out

                                                    to

                                                    do

                                                    bullYesbullYes

                                                    bullNobullYes

                                                    bullYesbullNo

                                                    bullNobullNo

                                                    Am I having fun nowIs

                                                    this

                                                    what

                                                    I se

                                                    t out

                                                    to

                                                    do

                                                    bullFunbullOn-task

                                                    bullNot funbullOn-task

                                                    bullFunbullNot on-task

                                                    bullNot funbullNot on-task

                                                    Key Features of Video Games

                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                    inappropriate behavior ndash never reverse this

                                                    Key Features of Video Games

                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                    Volkow et al 2004

                                                    Increase salience

                                                    Increase salience

                                                    Quarterly QI review

                                                    The post-mortem

                                                    Your 1 Organizational Tool

                                                    Your 1 Organizational Tool

                                                    Yoga read

                                                    Staff meeting

                                                    Planningsession

                                                    Phone calls

                                                    billing

                                                    Your 1 Organizational Tool

                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                    Your 1 Organizational Tool

                                                    Learn French

                                                    Stop smoking

                                                    Be a better spouse

                                                    The ldquoBig Fiverdquo

                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                    The ldquoBig Fiverdquo

                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                    The ldquoBig Fiverdquo

                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                    The ldquoBig Fiverdquo

                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                    The ldquoBig Fiverdquo

                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                    A CHALLENGEhellip

                                                    wwwDrNowellcom

                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                    DavidNowellSeminars

                                                    DavidNowell

                                                    • Slide 1
                                                    • hellipa challenge
                                                    • Slide 3
                                                    • Perspective of this workshophellip
                                                    • ldquoTop ndash downrdquo dysfunction
                                                    • ldquoBottom - uprdquo dysfunction
                                                    • Slide 7
                                                    • Whatrsquos the kidrsquos deal
                                                    • Overview
                                                    • This Dense Pudding
                                                    • Sensory Processing Disorder
                                                    • Slide 12
                                                    • Slide 13
                                                    • Developmental considerations
                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                    • Whatrsquos the kidrsquos deal (2)
                                                    • Slide 17
                                                    • Whatrsquos the kidrsquos deal (3)
                                                    • Slide 19
                                                    • Strategies
                                                    • Regulatory-Sensory Processing Disorders
                                                    • Slide 22
                                                    • Slide 23
                                                    • Regulatory-Sensory Processing Disorders (2)
                                                    • Slide 25
                                                    • Central Auditory Processing Disorder
                                                    • Slide 27
                                                    • Slide 28
                                                    • Slide 29
                                                    • Central Auditory Processing Disorder (2)
                                                    • Central Auditory Processing Disorder (3)
                                                    • Central Auditory Processing Disorder (4)
                                                    • CAPD or ADHD
                                                    • Whatrsquos the kidrsquos deal (4)
                                                    • Slide 35
                                                    • Strategies (2)
                                                    • (C)APD
                                                    • Treatment for CAPD
                                                    • Treatment for CAPD (2)
                                                    • Self-assessment
                                                    • Attention Deficit Hyperactivity Disorder
                                                    • Slide 42
                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                    • (85 ndash X) x 365
                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                    • Core symptoms
                                                    • Core symptoms (2)
                                                    • hellipand the rest of the criteria
                                                    • Slide 49
                                                    • Functional impact of core symptoms
                                                    • Functional impact of core symptoms (2)
                                                    • Functional impact of core symptoms (3)
                                                    • Slide 53
                                                    • Functional impact of core symptoms (4)
                                                    • Functional impact of core symptoms (5)
                                                    • Functional impact of core symptoms (6)
                                                    • Functional impact of core symptoms (7)
                                                    • Functional impact of core symptoms (8)
                                                    • Functional impact of core symptoms (9)
                                                    • Subtypes of ADHD
                                                    • Subtypes of ADHD (2)
                                                    • Common comorbidities with ADHD
                                                    • Slide 63
                                                    • Common comorbidities with ADHD (2)
                                                    • ADHD and girls
                                                    • Slide 66
                                                    • Slide 67
                                                    • ADHD and women
                                                    • Slide 69
                                                    • ADHD and women (2)
                                                    • Executive Functioning An Overarching Theme
                                                    • The Executive Functions
                                                    • The Executive Functions (2)
                                                    • Slide 74
                                                    • Slide 75
                                                    • Appropriate expectations
                                                    • Age-appropriate expectations
                                                    • Age-appropriate expectations (2)
                                                    • Age-appropriate expectations (3)
                                                    • Age-appropriate expectations (4)
                                                    • Age-appropriate expectations (5)
                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                    • Slide 84
                                                    • Slide 85
                                                    • Strategies (3)
                                                    • Pharmacotherapy
                                                    • Behavioral Supports
                                                    • Slide 89
                                                    • Slide 90
                                                    • Slide 91
                                                    • Slide 92
                                                    • Slide 93
                                                    • Slide 94
                                                    • Slide 95
                                                    • Slide 96
                                                    • Slide 97
                                                    • Slide 98
                                                    • Slide 99
                                                    • Slide 100
                                                    • Slide 101
                                                    • Slide 102
                                                    • Slide 103
                                                    • Slide 104
                                                    • Slide 105
                                                    • Slide 106
                                                    • Slide 107
                                                    • Slide 108
                                                    • Slide 109
                                                    • Slide 110
                                                    • Time Out
                                                    • Token economy
                                                    • Slide 113
                                                    • Slide 114
                                                    • Slide 115
                                                    • Intrinsic motivation
                                                    • Slide 117
                                                    • Slide 118
                                                    • Slide 119
                                                    • Metacognition
                                                    • ldquoLend Me Your Brainrdquo
                                                    • What Does Dopamine Feel Like
                                                    • Preferred States What Does Dopamine Feel Like
                                                    • Slide 124
                                                    • PREFERRED STATES INVENTORY
                                                    • PREFERRED STATES INVENTORY (2)
                                                    • PREFERRED STATES INVENTORY (3)
                                                    • Slide 128
                                                    • Slide 129
                                                    • Broaden and Build
                                                    • ldquoNeuroMalleabilityrdquo
                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                    • The reward-and-planning system
                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                    • The reward-and-planning system (2)
                                                    • Ways the reward-and-planning system can go wrong
                                                    • Ways the reward-and-planning system can go wrong (2)
                                                    • Ways the reward-and-planning system can go wrong (3)
                                                    • Ways the reward-and-planning system can go wrong (4)
                                                    • Slide 141
                                                    • Lend Me Your Brain
                                                    • Ways the reward-and-planning system can go wrong (5)
                                                    • Ways the reward-and-planning system can go wrong (6)
                                                    • Ways the reward-and-planning system can go wrong (7)
                                                    • Slide 146
                                                    • Ways the reward-and-planning system can go wrong (8)
                                                    • Ways the reward-and-planning system can go wrong (9)
                                                    • Slide 149
                                                    • Ways the reward-and-planning system can go wrong (10)
                                                    • Ways the reward-and-planning system can go wrong (11)
                                                    • Slide 152
                                                    • Ways the reward-and-planning system can go wrong (12)
                                                    • Slide 154
                                                    • Ways the reward-and-planning system can go wrong (13)
                                                    • Ways the reward-and-planning system can go wrong (14)
                                                    • Slide 157
                                                    • Slide 158
                                                    • Slide 159
                                                    • Ways the reward-and-planning system can go wrong (15)
                                                    • Ways the reward-and-planning system can go wrong (16)
                                                    • Slide 162
                                                    • Ways the reward-and-planning system can go wrong (17)
                                                    • Slide 164
                                                    • Instant gratification vs executive gratification
                                                    • Slide 166
                                                    • Slide 167
                                                    • Slide 168
                                                    • Slide 169
                                                    • Slide 170
                                                    • Self-Talk Proficiency
                                                    • Self-Talk Proficiency (2)
                                                    • Self-Talk Proficiency (3)
                                                    • Self-Talk Proficiency (4)
                                                    • Match the Picture
                                                    • Slide 176
                                                    • Slide 177
                                                    • Distraction Delay Training
                                                    • Slide 179
                                                    • Slide 180
                                                    • Executive Estimates Training
                                                    • Learning Time
                                                    • Learning Time (2)
                                                    • Learning Time (3)
                                                    • Slide 185
                                                    • Slide 186
                                                    • Learning Time (4)
                                                    • Asking two questionshellip
                                                    • Slide 189
                                                    • Slide 190
                                                    • Key Features of Video Games
                                                    • Key Features of Video Games (2)
                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                    • Slide 194
                                                    • Slide 195
                                                    • Slide 196
                                                    • Slide 197
                                                    • Slide 198
                                                    • Slide 199
                                                    • Slide 200
                                                    • Slide 201
                                                    • Quarterly QI review
                                                    • The post-mortem
                                                    • Slide 204
                                                    • Slide 205
                                                    • Slide 206
                                                    • Slide 207
                                                    • Slide 208
                                                    • Slide 209
                                                    • Slide 210
                                                    • The ldquoBig Fiverdquo
                                                    • Slide 212
                                                    • Slide 213
                                                    • The ldquoBig Fiverdquo (2)
                                                    • Slide 215
                                                    • Slide 216
                                                    • Slide 217
                                                    • The ldquoBig Fiverdquo (3)
                                                    • The ldquoBig Fiverdquo (4)
                                                    • The ldquoBig Fiverdquo (5)
                                                    • A challengehellip
                                                    • Slide 222

                                                      Treatment for CAPD

                                                      Environmental modifications

                                                      Treatment for CAPD

                                                      Compensatory Strategies

                                                      Self-assessment

                                                      >

                                                      Attention Deficit Hyperactivity Disorder

                                                      Increase salience

                                                      Attention Deficit Hyperactivity Disorder

                                                      (85 ndash X) x 365

                                                      ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                      Core symptoms

                                                      Inattention distractibility

                                                      Core symptoms

                                                      Hyperactivity impulsivity

                                                      hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                      mental disorder

                                                      Functional impact of core symptoms

                                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                      Functional impact of core symptoms

                                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                      Functional impact of core symptoms

                                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                      Functional impact of core symptoms

                                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                      Functional impact of core symptoms

                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                      Functional impact of core symptoms

                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                      Functional impact of core symptoms

                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                      Functional impact of core symptoms

                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                      Functional impact of core symptoms

                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                      Subtypes of ADHD

                                                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                      Subtypes of ADHD

                                                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                      Specifed

                                                      Common comorbidities with ADHD

                                                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                      processing challenges

                                                      Common comorbidities with ADHD

                                                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                      processing challenges

                                                      ADHD and girls

                                                      ADHD and women

                                                      ADHD and women

                                                      More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                      partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                      disorganization

                                                      Executive FunctioningAn Overarching Theme

                                                      Sensory Processing Disorder Central Auditory Processing

                                                      Disorder ADHD and Executive Dysfunction

                                                      The Executive Functions

                                                      Internalizing speech Previewing

                                                      Prioritizing Tempo control Inhibition

                                                      The Executive Functions

                                                      Determining salience (whatrsquos in it for me)

                                                      Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                      Appropriate expectations

                                                      Age-appropriate expectations

                                                      Preschool 1-step errands Chores with cues Basic inhibition

                                                      Age-appropriate expectations

                                                      K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                      3rd ndash 5th

                                                      Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                      Age-appropriate expectations

                                                      6th ndash 8th

                                                      complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                      Age-appropriate expectations

                                                      Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                      already made Take othersrsquo perspective

                                                      Age-appropriate expectations

                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                      Inter-connectedness of systems Cortico-striatal system for example

                                                      Strategies

                                                      Pharmacotherapy

                                                      X

                                                      Behavioral Supports

                                                      A B C

                                                      A B C

                                                      behavior

                                                      A B C

                                                      consequences

                                                      A B C

                                                      antecedent

                                                      A B C

                                                      A B C

                                                      antecedent

                                                      A B C

                                                      antecedent

                                                      easy hard

                                                      A B C

                                                      consequences

                                                      R P

                                                      +

                                                      -

                                                      R+ P+

                                                      R- P-

                                                      Time Out

                                                      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                      Token economy

                                                      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                      Intrinsic motivation

                                                      A B C

                                                      consequencesX

                                                      A B C

                                                      behavior

                                                      Metacognition

                                                      Metacognitive knowledge Metacognitive strategies

                                                      ldquoLend Me Your Brainrdquo

                                                      What Does Dopamine Feel Like

                                                      The Physiology of Motivation and Reward

                                                      Preferred States What Does Dopamine Feel Like

                                                      1 Great experience2 Kodak moment3 The feeeeling

                                                      David D Nowell PhD189 May Street

                                                      Worcester Mass 01602DrNowellcom

                                                      PREFERRED STATES INVENTORY

                                                      wwwLulucom

                                                      Identify 20 peak experiences For each peak experience identify the

                                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                      of that moment Name it Check the 20 peak moment-feelings for

                                                      clusters groupings There will probably be 4 or 5

                                                      PREFERRED STATES INVENTORY

                                                      Find a word a label for each of the groupings

                                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                      ldquovaluesrdquo ways that you really like to feel

                                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                      PREFERRED STATES INVENTORY

                                                      PREFERRED STATES INVENTORY

                                                      Broaden and Build

                                                      ldquoNeuroMalleabilityrdquo

                                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                      The reward-and-planning system

                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                      The reward-and-planning system

                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                      Ways the reward-and-planning system can go wrong

                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                      Ways the reward-and-planning system can go wrong

                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                      Ways the reward-and-planning system can go wrong

                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                      Ways the reward-and-planning system can go wrong

                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                      Lend Me Your Brain

                                                      Supporting Clients with Executive Dysfunction

                                                      Ways the reward-and-planning system can go wrong

                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                      Ways the reward-and-planning system can go wrong

                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                      Ways the reward-and-planning system can go wrong

                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                      Ways the reward-and-planning system can go wrong

                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                      Too busy with current activity

                                                      Field dependent

                                                      Ways the reward-and-planning system can go wrong

                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                      Ways the reward-and-planning system can go wrong

                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                      Ways the reward-and-planning system can go wrong

                                                      Sequence problem-solve

                                                      Ways the reward-and-planning system can go wrong

                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                      Ways the reward-and-planning system can go wrong

                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                      Ways the reward-and-planning system can go wrong

                                                      Block out distractions

                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                      - E Goldberg

                                                      Ways the reward-and-planning system can go wrong

                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                      Ways the reward-and-planning system can go wrong

                                                      Get the reward

                                                      Ways the reward-and-planning system can go wrong

                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                      Instant gratification vs

                                                      executive gratification

                                                      A B C

                                                      behaviorx

                                                      Self-Talk Proficiency

                                                      Self-Talk Proficiency

                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                      takerdquordquo

                                                      Self-Talk Proficiency

                                                      bull -ldquoHow are you going to know what you needrdquo

                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                      bull -ldquoHow will you know when you are donerdquo

                                                      Self-Talk Proficiency

                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                      thathelliprdquo

                                                      Match the Picture

                                                      Distraction Delay Training

                                                      Executive Estimates Training

                                                      X

                                                      Learning Time

                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                      Learning Time

                                                      Learning Time

                                                      Learning Time

                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                      Asking two questionshellip

                                                      Am I having fun now And is this what I set out to do

                                                      Am I having fun nowIs

                                                      this

                                                      what

                                                      I se

                                                      t out

                                                      to

                                                      do

                                                      bullYesbullYes

                                                      bullNobullYes

                                                      bullYesbullNo

                                                      bullNobullNo

                                                      Am I having fun nowIs

                                                      this

                                                      what

                                                      I se

                                                      t out

                                                      to

                                                      do

                                                      bullFunbullOn-task

                                                      bullNot funbullOn-task

                                                      bullFunbullNot on-task

                                                      bullNot funbullNot on-task

                                                      Key Features of Video Games

                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                      inappropriate behavior ndash never reverse this

                                                      Key Features of Video Games

                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                      Volkow et al 2004

                                                      Increase salience

                                                      Increase salience

                                                      Quarterly QI review

                                                      The post-mortem

                                                      Your 1 Organizational Tool

                                                      Your 1 Organizational Tool

                                                      Yoga read

                                                      Staff meeting

                                                      Planningsession

                                                      Phone calls

                                                      billing

                                                      Your 1 Organizational Tool

                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                      Your 1 Organizational Tool

                                                      Learn French

                                                      Stop smoking

                                                      Be a better spouse

                                                      The ldquoBig Fiverdquo

                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                      The ldquoBig Fiverdquo

                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                      The ldquoBig Fiverdquo

                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                      The ldquoBig Fiverdquo

                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                      The ldquoBig Fiverdquo

                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                      A CHALLENGEhellip

                                                      wwwDrNowellcom

                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                      DavidNowellSeminars

                                                      DavidNowell

                                                      • Slide 1
                                                      • hellipa challenge
                                                      • Slide 3
                                                      • Perspective of this workshophellip
                                                      • ldquoTop ndash downrdquo dysfunction
                                                      • ldquoBottom - uprdquo dysfunction
                                                      • Slide 7
                                                      • Whatrsquos the kidrsquos deal
                                                      • Overview
                                                      • This Dense Pudding
                                                      • Sensory Processing Disorder
                                                      • Slide 12
                                                      • Slide 13
                                                      • Developmental considerations
                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                      • Whatrsquos the kidrsquos deal (2)
                                                      • Slide 17
                                                      • Whatrsquos the kidrsquos deal (3)
                                                      • Slide 19
                                                      • Strategies
                                                      • Regulatory-Sensory Processing Disorders
                                                      • Slide 22
                                                      • Slide 23
                                                      • Regulatory-Sensory Processing Disorders (2)
                                                      • Slide 25
                                                      • Central Auditory Processing Disorder
                                                      • Slide 27
                                                      • Slide 28
                                                      • Slide 29
                                                      • Central Auditory Processing Disorder (2)
                                                      • Central Auditory Processing Disorder (3)
                                                      • Central Auditory Processing Disorder (4)
                                                      • CAPD or ADHD
                                                      • Whatrsquos the kidrsquos deal (4)
                                                      • Slide 35
                                                      • Strategies (2)
                                                      • (C)APD
                                                      • Treatment for CAPD
                                                      • Treatment for CAPD (2)
                                                      • Self-assessment
                                                      • Attention Deficit Hyperactivity Disorder
                                                      • Slide 42
                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                      • (85 ndash X) x 365
                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                      • Core symptoms
                                                      • Core symptoms (2)
                                                      • hellipand the rest of the criteria
                                                      • Slide 49
                                                      • Functional impact of core symptoms
                                                      • Functional impact of core symptoms (2)
                                                      • Functional impact of core symptoms (3)
                                                      • Slide 53
                                                      • Functional impact of core symptoms (4)
                                                      • Functional impact of core symptoms (5)
                                                      • Functional impact of core symptoms (6)
                                                      • Functional impact of core symptoms (7)
                                                      • Functional impact of core symptoms (8)
                                                      • Functional impact of core symptoms (9)
                                                      • Subtypes of ADHD
                                                      • Subtypes of ADHD (2)
                                                      • Common comorbidities with ADHD
                                                      • Slide 63
                                                      • Common comorbidities with ADHD (2)
                                                      • ADHD and girls
                                                      • Slide 66
                                                      • Slide 67
                                                      • ADHD and women
                                                      • Slide 69
                                                      • ADHD and women (2)
                                                      • Executive Functioning An Overarching Theme
                                                      • The Executive Functions
                                                      • The Executive Functions (2)
                                                      • Slide 74
                                                      • Slide 75
                                                      • Appropriate expectations
                                                      • Age-appropriate expectations
                                                      • Age-appropriate expectations (2)
                                                      • Age-appropriate expectations (3)
                                                      • Age-appropriate expectations (4)
                                                      • Age-appropriate expectations (5)
                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                      • Slide 84
                                                      • Slide 85
                                                      • Strategies (3)
                                                      • Pharmacotherapy
                                                      • Behavioral Supports
                                                      • Slide 89
                                                      • Slide 90
                                                      • Slide 91
                                                      • Slide 92
                                                      • Slide 93
                                                      • Slide 94
                                                      • Slide 95
                                                      • Slide 96
                                                      • Slide 97
                                                      • Slide 98
                                                      • Slide 99
                                                      • Slide 100
                                                      • Slide 101
                                                      • Slide 102
                                                      • Slide 103
                                                      • Slide 104
                                                      • Slide 105
                                                      • Slide 106
                                                      • Slide 107
                                                      • Slide 108
                                                      • Slide 109
                                                      • Slide 110
                                                      • Time Out
                                                      • Token economy
                                                      • Slide 113
                                                      • Slide 114
                                                      • Slide 115
                                                      • Intrinsic motivation
                                                      • Slide 117
                                                      • Slide 118
                                                      • Slide 119
                                                      • Metacognition
                                                      • ldquoLend Me Your Brainrdquo
                                                      • What Does Dopamine Feel Like
                                                      • Preferred States What Does Dopamine Feel Like
                                                      • Slide 124
                                                      • PREFERRED STATES INVENTORY
                                                      • PREFERRED STATES INVENTORY (2)
                                                      • PREFERRED STATES INVENTORY (3)
                                                      • Slide 128
                                                      • Slide 129
                                                      • Broaden and Build
                                                      • ldquoNeuroMalleabilityrdquo
                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                      • The reward-and-planning system
                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                      • The reward-and-planning system (2)
                                                      • Ways the reward-and-planning system can go wrong
                                                      • Ways the reward-and-planning system can go wrong (2)
                                                      • Ways the reward-and-planning system can go wrong (3)
                                                      • Ways the reward-and-planning system can go wrong (4)
                                                      • Slide 141
                                                      • Lend Me Your Brain
                                                      • Ways the reward-and-planning system can go wrong (5)
                                                      • Ways the reward-and-planning system can go wrong (6)
                                                      • Ways the reward-and-planning system can go wrong (7)
                                                      • Slide 146
                                                      • Ways the reward-and-planning system can go wrong (8)
                                                      • Ways the reward-and-planning system can go wrong (9)
                                                      • Slide 149
                                                      • Ways the reward-and-planning system can go wrong (10)
                                                      • Ways the reward-and-planning system can go wrong (11)
                                                      • Slide 152
                                                      • Ways the reward-and-planning system can go wrong (12)
                                                      • Slide 154
                                                      • Ways the reward-and-planning system can go wrong (13)
                                                      • Ways the reward-and-planning system can go wrong (14)
                                                      • Slide 157
                                                      • Slide 158
                                                      • Slide 159
                                                      • Ways the reward-and-planning system can go wrong (15)
                                                      • Ways the reward-and-planning system can go wrong (16)
                                                      • Slide 162
                                                      • Ways the reward-and-planning system can go wrong (17)
                                                      • Slide 164
                                                      • Instant gratification vs executive gratification
                                                      • Slide 166
                                                      • Slide 167
                                                      • Slide 168
                                                      • Slide 169
                                                      • Slide 170
                                                      • Self-Talk Proficiency
                                                      • Self-Talk Proficiency (2)
                                                      • Self-Talk Proficiency (3)
                                                      • Self-Talk Proficiency (4)
                                                      • Match the Picture
                                                      • Slide 176
                                                      • Slide 177
                                                      • Distraction Delay Training
                                                      • Slide 179
                                                      • Slide 180
                                                      • Executive Estimates Training
                                                      • Learning Time
                                                      • Learning Time (2)
                                                      • Learning Time (3)
                                                      • Slide 185
                                                      • Slide 186
                                                      • Learning Time (4)
                                                      • Asking two questionshellip
                                                      • Slide 189
                                                      • Slide 190
                                                      • Key Features of Video Games
                                                      • Key Features of Video Games (2)
                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                      • Slide 194
                                                      • Slide 195
                                                      • Slide 196
                                                      • Slide 197
                                                      • Slide 198
                                                      • Slide 199
                                                      • Slide 200
                                                      • Slide 201
                                                      • Quarterly QI review
                                                      • The post-mortem
                                                      • Slide 204
                                                      • Slide 205
                                                      • Slide 206
                                                      • Slide 207
                                                      • Slide 208
                                                      • Slide 209
                                                      • Slide 210
                                                      • The ldquoBig Fiverdquo
                                                      • Slide 212
                                                      • Slide 213
                                                      • The ldquoBig Fiverdquo (2)
                                                      • Slide 215
                                                      • Slide 216
                                                      • Slide 217
                                                      • The ldquoBig Fiverdquo (3)
                                                      • The ldquoBig Fiverdquo (4)
                                                      • The ldquoBig Fiverdquo (5)
                                                      • A challengehellip
                                                      • Slide 222

                                                        Treatment for CAPD

                                                        Compensatory Strategies

                                                        Self-assessment

                                                        >

                                                        Attention Deficit Hyperactivity Disorder

                                                        Increase salience

                                                        Attention Deficit Hyperactivity Disorder

                                                        (85 ndash X) x 365

                                                        ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                        Core symptoms

                                                        Inattention distractibility

                                                        Core symptoms

                                                        Hyperactivity impulsivity

                                                        hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                        mental disorder

                                                        Functional impact of core symptoms

                                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                        Functional impact of core symptoms

                                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                        Functional impact of core symptoms

                                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                        Functional impact of core symptoms

                                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                        Functional impact of core symptoms

                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                        Functional impact of core symptoms

                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                        Functional impact of core symptoms

                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                        Functional impact of core symptoms

                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                        Functional impact of core symptoms

                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                        Subtypes of ADHD

                                                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                        Subtypes of ADHD

                                                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                        Specifed

                                                        Common comorbidities with ADHD

                                                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                        processing challenges

                                                        Common comorbidities with ADHD

                                                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                        processing challenges

                                                        ADHD and girls

                                                        ADHD and women

                                                        ADHD and women

                                                        More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                        partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                        disorganization

                                                        Executive FunctioningAn Overarching Theme

                                                        Sensory Processing Disorder Central Auditory Processing

                                                        Disorder ADHD and Executive Dysfunction

                                                        The Executive Functions

                                                        Internalizing speech Previewing

                                                        Prioritizing Tempo control Inhibition

                                                        The Executive Functions

                                                        Determining salience (whatrsquos in it for me)

                                                        Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                        Appropriate expectations

                                                        Age-appropriate expectations

                                                        Preschool 1-step errands Chores with cues Basic inhibition

                                                        Age-appropriate expectations

                                                        K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                        3rd ndash 5th

                                                        Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                        Age-appropriate expectations

                                                        6th ndash 8th

                                                        complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                        Age-appropriate expectations

                                                        Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                        already made Take othersrsquo perspective

                                                        Age-appropriate expectations

                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                        Inter-connectedness of systems Cortico-striatal system for example

                                                        Strategies

                                                        Pharmacotherapy

                                                        X

                                                        Behavioral Supports

                                                        A B C

                                                        A B C

                                                        behavior

                                                        A B C

                                                        consequences

                                                        A B C

                                                        antecedent

                                                        A B C

                                                        A B C

                                                        antecedent

                                                        A B C

                                                        antecedent

                                                        easy hard

                                                        A B C

                                                        consequences

                                                        R P

                                                        +

                                                        -

                                                        R+ P+

                                                        R- P-

                                                        Time Out

                                                        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                        Token economy

                                                        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                        Intrinsic motivation

                                                        A B C

                                                        consequencesX

                                                        A B C

                                                        behavior

                                                        Metacognition

                                                        Metacognitive knowledge Metacognitive strategies

                                                        ldquoLend Me Your Brainrdquo

                                                        What Does Dopamine Feel Like

                                                        The Physiology of Motivation and Reward

                                                        Preferred States What Does Dopamine Feel Like

                                                        1 Great experience2 Kodak moment3 The feeeeling

                                                        David D Nowell PhD189 May Street

                                                        Worcester Mass 01602DrNowellcom

                                                        PREFERRED STATES INVENTORY

                                                        wwwLulucom

                                                        Identify 20 peak experiences For each peak experience identify the

                                                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                        of that moment Name it Check the 20 peak moment-feelings for

                                                        clusters groupings There will probably be 4 or 5

                                                        PREFERRED STATES INVENTORY

                                                        Find a word a label for each of the groupings

                                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                        ldquovaluesrdquo ways that you really like to feel

                                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                        PREFERRED STATES INVENTORY

                                                        PREFERRED STATES INVENTORY

                                                        Broaden and Build

                                                        ldquoNeuroMalleabilityrdquo

                                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                        The reward-and-planning system

                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                        The reward-and-planning system

                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                        Ways the reward-and-planning system can go wrong

                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                        Ways the reward-and-planning system can go wrong

                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                        Ways the reward-and-planning system can go wrong

                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                        Ways the reward-and-planning system can go wrong

                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                        Lend Me Your Brain

                                                        Supporting Clients with Executive Dysfunction

                                                        Ways the reward-and-planning system can go wrong

                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                        Ways the reward-and-planning system can go wrong

                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                        Ways the reward-and-planning system can go wrong

                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                        Ways the reward-and-planning system can go wrong

                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                        Too busy with current activity

                                                        Field dependent

                                                        Ways the reward-and-planning system can go wrong

                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                        Ways the reward-and-planning system can go wrong

                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                        Ways the reward-and-planning system can go wrong

                                                        Sequence problem-solve

                                                        Ways the reward-and-planning system can go wrong

                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                        Ways the reward-and-planning system can go wrong

                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                        Ways the reward-and-planning system can go wrong

                                                        Block out distractions

                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                        - E Goldberg

                                                        Ways the reward-and-planning system can go wrong

                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                        Ways the reward-and-planning system can go wrong

                                                        Get the reward

                                                        Ways the reward-and-planning system can go wrong

                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                        Instant gratification vs

                                                        executive gratification

                                                        A B C

                                                        behaviorx

                                                        Self-Talk Proficiency

                                                        Self-Talk Proficiency

                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                        takerdquordquo

                                                        Self-Talk Proficiency

                                                        bull -ldquoHow are you going to know what you needrdquo

                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                        bull -ldquoHow will you know when you are donerdquo

                                                        Self-Talk Proficiency

                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                        thathelliprdquo

                                                        Match the Picture

                                                        Distraction Delay Training

                                                        Executive Estimates Training

                                                        X

                                                        Learning Time

                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                        Learning Time

                                                        Learning Time

                                                        Learning Time

                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                        Asking two questionshellip

                                                        Am I having fun now And is this what I set out to do

                                                        Am I having fun nowIs

                                                        this

                                                        what

                                                        I se

                                                        t out

                                                        to

                                                        do

                                                        bullYesbullYes

                                                        bullNobullYes

                                                        bullYesbullNo

                                                        bullNobullNo

                                                        Am I having fun nowIs

                                                        this

                                                        what

                                                        I se

                                                        t out

                                                        to

                                                        do

                                                        bullFunbullOn-task

                                                        bullNot funbullOn-task

                                                        bullFunbullNot on-task

                                                        bullNot funbullNot on-task

                                                        Key Features of Video Games

                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                        inappropriate behavior ndash never reverse this

                                                        Key Features of Video Games

                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                        Volkow et al 2004

                                                        Increase salience

                                                        Increase salience

                                                        Quarterly QI review

                                                        The post-mortem

                                                        Your 1 Organizational Tool

                                                        Your 1 Organizational Tool

                                                        Yoga read

                                                        Staff meeting

                                                        Planningsession

                                                        Phone calls

                                                        billing

                                                        Your 1 Organizational Tool

                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                        Your 1 Organizational Tool

                                                        Learn French

                                                        Stop smoking

                                                        Be a better spouse

                                                        The ldquoBig Fiverdquo

                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                        The ldquoBig Fiverdquo

                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                        The ldquoBig Fiverdquo

                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                        The ldquoBig Fiverdquo

                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                        The ldquoBig Fiverdquo

                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                        A CHALLENGEhellip

                                                        wwwDrNowellcom

                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                        DavidNowellSeminars

                                                        DavidNowell

                                                        • Slide 1
                                                        • hellipa challenge
                                                        • Slide 3
                                                        • Perspective of this workshophellip
                                                        • ldquoTop ndash downrdquo dysfunction
                                                        • ldquoBottom - uprdquo dysfunction
                                                        • Slide 7
                                                        • Whatrsquos the kidrsquos deal
                                                        • Overview
                                                        • This Dense Pudding
                                                        • Sensory Processing Disorder
                                                        • Slide 12
                                                        • Slide 13
                                                        • Developmental considerations
                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                        • Whatrsquos the kidrsquos deal (2)
                                                        • Slide 17
                                                        • Whatrsquos the kidrsquos deal (3)
                                                        • Slide 19
                                                        • Strategies
                                                        • Regulatory-Sensory Processing Disorders
                                                        • Slide 22
                                                        • Slide 23
                                                        • Regulatory-Sensory Processing Disorders (2)
                                                        • Slide 25
                                                        • Central Auditory Processing Disorder
                                                        • Slide 27
                                                        • Slide 28
                                                        • Slide 29
                                                        • Central Auditory Processing Disorder (2)
                                                        • Central Auditory Processing Disorder (3)
                                                        • Central Auditory Processing Disorder (4)
                                                        • CAPD or ADHD
                                                        • Whatrsquos the kidrsquos deal (4)
                                                        • Slide 35
                                                        • Strategies (2)
                                                        • (C)APD
                                                        • Treatment for CAPD
                                                        • Treatment for CAPD (2)
                                                        • Self-assessment
                                                        • Attention Deficit Hyperactivity Disorder
                                                        • Slide 42
                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                        • (85 ndash X) x 365
                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                        • Core symptoms
                                                        • Core symptoms (2)
                                                        • hellipand the rest of the criteria
                                                        • Slide 49
                                                        • Functional impact of core symptoms
                                                        • Functional impact of core symptoms (2)
                                                        • Functional impact of core symptoms (3)
                                                        • Slide 53
                                                        • Functional impact of core symptoms (4)
                                                        • Functional impact of core symptoms (5)
                                                        • Functional impact of core symptoms (6)
                                                        • Functional impact of core symptoms (7)
                                                        • Functional impact of core symptoms (8)
                                                        • Functional impact of core symptoms (9)
                                                        • Subtypes of ADHD
                                                        • Subtypes of ADHD (2)
                                                        • Common comorbidities with ADHD
                                                        • Slide 63
                                                        • Common comorbidities with ADHD (2)
                                                        • ADHD and girls
                                                        • Slide 66
                                                        • Slide 67
                                                        • ADHD and women
                                                        • Slide 69
                                                        • ADHD and women (2)
                                                        • Executive Functioning An Overarching Theme
                                                        • The Executive Functions
                                                        • The Executive Functions (2)
                                                        • Slide 74
                                                        • Slide 75
                                                        • Appropriate expectations
                                                        • Age-appropriate expectations
                                                        • Age-appropriate expectations (2)
                                                        • Age-appropriate expectations (3)
                                                        • Age-appropriate expectations (4)
                                                        • Age-appropriate expectations (5)
                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                        • Slide 84
                                                        • Slide 85
                                                        • Strategies (3)
                                                        • Pharmacotherapy
                                                        • Behavioral Supports
                                                        • Slide 89
                                                        • Slide 90
                                                        • Slide 91
                                                        • Slide 92
                                                        • Slide 93
                                                        • Slide 94
                                                        • Slide 95
                                                        • Slide 96
                                                        • Slide 97
                                                        • Slide 98
                                                        • Slide 99
                                                        • Slide 100
                                                        • Slide 101
                                                        • Slide 102
                                                        • Slide 103
                                                        • Slide 104
                                                        • Slide 105
                                                        • Slide 106
                                                        • Slide 107
                                                        • Slide 108
                                                        • Slide 109
                                                        • Slide 110
                                                        • Time Out
                                                        • Token economy
                                                        • Slide 113
                                                        • Slide 114
                                                        • Slide 115
                                                        • Intrinsic motivation
                                                        • Slide 117
                                                        • Slide 118
                                                        • Slide 119
                                                        • Metacognition
                                                        • ldquoLend Me Your Brainrdquo
                                                        • What Does Dopamine Feel Like
                                                        • Preferred States What Does Dopamine Feel Like
                                                        • Slide 124
                                                        • PREFERRED STATES INVENTORY
                                                        • PREFERRED STATES INVENTORY (2)
                                                        • PREFERRED STATES INVENTORY (3)
                                                        • Slide 128
                                                        • Slide 129
                                                        • Broaden and Build
                                                        • ldquoNeuroMalleabilityrdquo
                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                        • The reward-and-planning system
                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                        • The reward-and-planning system (2)
                                                        • Ways the reward-and-planning system can go wrong
                                                        • Ways the reward-and-planning system can go wrong (2)
                                                        • Ways the reward-and-planning system can go wrong (3)
                                                        • Ways the reward-and-planning system can go wrong (4)
                                                        • Slide 141
                                                        • Lend Me Your Brain
                                                        • Ways the reward-and-planning system can go wrong (5)
                                                        • Ways the reward-and-planning system can go wrong (6)
                                                        • Ways the reward-and-planning system can go wrong (7)
                                                        • Slide 146
                                                        • Ways the reward-and-planning system can go wrong (8)
                                                        • Ways the reward-and-planning system can go wrong (9)
                                                        • Slide 149
                                                        • Ways the reward-and-planning system can go wrong (10)
                                                        • Ways the reward-and-planning system can go wrong (11)
                                                        • Slide 152
                                                        • Ways the reward-and-planning system can go wrong (12)
                                                        • Slide 154
                                                        • Ways the reward-and-planning system can go wrong (13)
                                                        • Ways the reward-and-planning system can go wrong (14)
                                                        • Slide 157
                                                        • Slide 158
                                                        • Slide 159
                                                        • Ways the reward-and-planning system can go wrong (15)
                                                        • Ways the reward-and-planning system can go wrong (16)
                                                        • Slide 162
                                                        • Ways the reward-and-planning system can go wrong (17)
                                                        • Slide 164
                                                        • Instant gratification vs executive gratification
                                                        • Slide 166
                                                        • Slide 167
                                                        • Slide 168
                                                        • Slide 169
                                                        • Slide 170
                                                        • Self-Talk Proficiency
                                                        • Self-Talk Proficiency (2)
                                                        • Self-Talk Proficiency (3)
                                                        • Self-Talk Proficiency (4)
                                                        • Match the Picture
                                                        • Slide 176
                                                        • Slide 177
                                                        • Distraction Delay Training
                                                        • Slide 179
                                                        • Slide 180
                                                        • Executive Estimates Training
                                                        • Learning Time
                                                        • Learning Time (2)
                                                        • Learning Time (3)
                                                        • Slide 185
                                                        • Slide 186
                                                        • Learning Time (4)
                                                        • Asking two questionshellip
                                                        • Slide 189
                                                        • Slide 190
                                                        • Key Features of Video Games
                                                        • Key Features of Video Games (2)
                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                        • Slide 194
                                                        • Slide 195
                                                        • Slide 196
                                                        • Slide 197
                                                        • Slide 198
                                                        • Slide 199
                                                        • Slide 200
                                                        • Slide 201
                                                        • Quarterly QI review
                                                        • The post-mortem
                                                        • Slide 204
                                                        • Slide 205
                                                        • Slide 206
                                                        • Slide 207
                                                        • Slide 208
                                                        • Slide 209
                                                        • Slide 210
                                                        • The ldquoBig Fiverdquo
                                                        • Slide 212
                                                        • Slide 213
                                                        • The ldquoBig Fiverdquo (2)
                                                        • Slide 215
                                                        • Slide 216
                                                        • Slide 217
                                                        • The ldquoBig Fiverdquo (3)
                                                        • The ldquoBig Fiverdquo (4)
                                                        • The ldquoBig Fiverdquo (5)
                                                        • A challengehellip
                                                        • Slide 222

                                                          Self-assessment

                                                          >

                                                          Attention Deficit Hyperactivity Disorder

                                                          Increase salience

                                                          Attention Deficit Hyperactivity Disorder

                                                          (85 ndash X) x 365

                                                          ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                          Core symptoms

                                                          Inattention distractibility

                                                          Core symptoms

                                                          Hyperactivity impulsivity

                                                          hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                          mental disorder

                                                          Functional impact of core symptoms

                                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                          Functional impact of core symptoms

                                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                          Functional impact of core symptoms

                                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                          Functional impact of core symptoms

                                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                          Functional impact of core symptoms

                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                          Functional impact of core symptoms

                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                          Functional impact of core symptoms

                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                          Functional impact of core symptoms

                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                          Functional impact of core symptoms

                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                          Subtypes of ADHD

                                                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                          Subtypes of ADHD

                                                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                          Specifed

                                                          Common comorbidities with ADHD

                                                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                          processing challenges

                                                          Common comorbidities with ADHD

                                                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                          processing challenges

                                                          ADHD and girls

                                                          ADHD and women

                                                          ADHD and women

                                                          More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                          partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                          disorganization

                                                          Executive FunctioningAn Overarching Theme

                                                          Sensory Processing Disorder Central Auditory Processing

                                                          Disorder ADHD and Executive Dysfunction

                                                          The Executive Functions

                                                          Internalizing speech Previewing

                                                          Prioritizing Tempo control Inhibition

                                                          The Executive Functions

                                                          Determining salience (whatrsquos in it for me)

                                                          Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                          Appropriate expectations

                                                          Age-appropriate expectations

                                                          Preschool 1-step errands Chores with cues Basic inhibition

                                                          Age-appropriate expectations

                                                          K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                          3rd ndash 5th

                                                          Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                          Age-appropriate expectations

                                                          6th ndash 8th

                                                          complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                          Age-appropriate expectations

                                                          Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                          already made Take othersrsquo perspective

                                                          Age-appropriate expectations

                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                          Inter-connectedness of systems Cortico-striatal system for example

                                                          Strategies

                                                          Pharmacotherapy

                                                          X

                                                          Behavioral Supports

                                                          A B C

                                                          A B C

                                                          behavior

                                                          A B C

                                                          consequences

                                                          A B C

                                                          antecedent

                                                          A B C

                                                          A B C

                                                          antecedent

                                                          A B C

                                                          antecedent

                                                          easy hard

                                                          A B C

                                                          consequences

                                                          R P

                                                          +

                                                          -

                                                          R+ P+

                                                          R- P-

                                                          Time Out

                                                          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                          Token economy

                                                          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                          Intrinsic motivation

                                                          A B C

                                                          consequencesX

                                                          A B C

                                                          behavior

                                                          Metacognition

                                                          Metacognitive knowledge Metacognitive strategies

                                                          ldquoLend Me Your Brainrdquo

                                                          What Does Dopamine Feel Like

                                                          The Physiology of Motivation and Reward

                                                          Preferred States What Does Dopamine Feel Like

                                                          1 Great experience2 Kodak moment3 The feeeeling

                                                          David D Nowell PhD189 May Street

                                                          Worcester Mass 01602DrNowellcom

                                                          PREFERRED STATES INVENTORY

                                                          wwwLulucom

                                                          Identify 20 peak experiences For each peak experience identify the

                                                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                          of that moment Name it Check the 20 peak moment-feelings for

                                                          clusters groupings There will probably be 4 or 5

                                                          PREFERRED STATES INVENTORY

                                                          Find a word a label for each of the groupings

                                                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                          ldquovaluesrdquo ways that you really like to feel

                                                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                          PREFERRED STATES INVENTORY

                                                          PREFERRED STATES INVENTORY

                                                          Broaden and Build

                                                          ldquoNeuroMalleabilityrdquo

                                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                          The reward-and-planning system

                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                          The reward-and-planning system

                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                          Ways the reward-and-planning system can go wrong

                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                          Ways the reward-and-planning system can go wrong

                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                          Ways the reward-and-planning system can go wrong

                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                          Ways the reward-and-planning system can go wrong

                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                          Lend Me Your Brain

                                                          Supporting Clients with Executive Dysfunction

                                                          Ways the reward-and-planning system can go wrong

                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                          Ways the reward-and-planning system can go wrong

                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                          Ways the reward-and-planning system can go wrong

                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                          Ways the reward-and-planning system can go wrong

                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                          Too busy with current activity

                                                          Field dependent

                                                          Ways the reward-and-planning system can go wrong

                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                          Ways the reward-and-planning system can go wrong

                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                          Ways the reward-and-planning system can go wrong

                                                          Sequence problem-solve

                                                          Ways the reward-and-planning system can go wrong

                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                          Ways the reward-and-planning system can go wrong

                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                          Ways the reward-and-planning system can go wrong

                                                          Block out distractions

                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                          - E Goldberg

                                                          Ways the reward-and-planning system can go wrong

                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                          Ways the reward-and-planning system can go wrong

                                                          Get the reward

                                                          Ways the reward-and-planning system can go wrong

                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                          Instant gratification vs

                                                          executive gratification

                                                          A B C

                                                          behaviorx

                                                          Self-Talk Proficiency

                                                          Self-Talk Proficiency

                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                          takerdquordquo

                                                          Self-Talk Proficiency

                                                          bull -ldquoHow are you going to know what you needrdquo

                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                          bull -ldquoHow will you know when you are donerdquo

                                                          Self-Talk Proficiency

                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                          thathelliprdquo

                                                          Match the Picture

                                                          Distraction Delay Training

                                                          Executive Estimates Training

                                                          X

                                                          Learning Time

                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                          Learning Time

                                                          Learning Time

                                                          Learning Time

                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                          Asking two questionshellip

                                                          Am I having fun now And is this what I set out to do

                                                          Am I having fun nowIs

                                                          this

                                                          what

                                                          I se

                                                          t out

                                                          to

                                                          do

                                                          bullYesbullYes

                                                          bullNobullYes

                                                          bullYesbullNo

                                                          bullNobullNo

                                                          Am I having fun nowIs

                                                          this

                                                          what

                                                          I se

                                                          t out

                                                          to

                                                          do

                                                          bullFunbullOn-task

                                                          bullNot funbullOn-task

                                                          bullFunbullNot on-task

                                                          bullNot funbullNot on-task

                                                          Key Features of Video Games

                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                          inappropriate behavior ndash never reverse this

                                                          Key Features of Video Games

                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                          Volkow et al 2004

                                                          Increase salience

                                                          Increase salience

                                                          Quarterly QI review

                                                          The post-mortem

                                                          Your 1 Organizational Tool

                                                          Your 1 Organizational Tool

                                                          Yoga read

                                                          Staff meeting

                                                          Planningsession

                                                          Phone calls

                                                          billing

                                                          Your 1 Organizational Tool

                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                          Your 1 Organizational Tool

                                                          Learn French

                                                          Stop smoking

                                                          Be a better spouse

                                                          The ldquoBig Fiverdquo

                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                          The ldquoBig Fiverdquo

                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                          The ldquoBig Fiverdquo

                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                          The ldquoBig Fiverdquo

                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                          The ldquoBig Fiverdquo

                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                          A CHALLENGEhellip

                                                          wwwDrNowellcom

                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                          DavidNowellSeminars

                                                          DavidNowell

                                                          • Slide 1
                                                          • hellipa challenge
                                                          • Slide 3
                                                          • Perspective of this workshophellip
                                                          • ldquoTop ndash downrdquo dysfunction
                                                          • ldquoBottom - uprdquo dysfunction
                                                          • Slide 7
                                                          • Whatrsquos the kidrsquos deal
                                                          • Overview
                                                          • This Dense Pudding
                                                          • Sensory Processing Disorder
                                                          • Slide 12
                                                          • Slide 13
                                                          • Developmental considerations
                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                          • Whatrsquos the kidrsquos deal (2)
                                                          • Slide 17
                                                          • Whatrsquos the kidrsquos deal (3)
                                                          • Slide 19
                                                          • Strategies
                                                          • Regulatory-Sensory Processing Disorders
                                                          • Slide 22
                                                          • Slide 23
                                                          • Regulatory-Sensory Processing Disorders (2)
                                                          • Slide 25
                                                          • Central Auditory Processing Disorder
                                                          • Slide 27
                                                          • Slide 28
                                                          • Slide 29
                                                          • Central Auditory Processing Disorder (2)
                                                          • Central Auditory Processing Disorder (3)
                                                          • Central Auditory Processing Disorder (4)
                                                          • CAPD or ADHD
                                                          • Whatrsquos the kidrsquos deal (4)
                                                          • Slide 35
                                                          • Strategies (2)
                                                          • (C)APD
                                                          • Treatment for CAPD
                                                          • Treatment for CAPD (2)
                                                          • Self-assessment
                                                          • Attention Deficit Hyperactivity Disorder
                                                          • Slide 42
                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                          • (85 ndash X) x 365
                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                          • Core symptoms
                                                          • Core symptoms (2)
                                                          • hellipand the rest of the criteria
                                                          • Slide 49
                                                          • Functional impact of core symptoms
                                                          • Functional impact of core symptoms (2)
                                                          • Functional impact of core symptoms (3)
                                                          • Slide 53
                                                          • Functional impact of core symptoms (4)
                                                          • Functional impact of core symptoms (5)
                                                          • Functional impact of core symptoms (6)
                                                          • Functional impact of core symptoms (7)
                                                          • Functional impact of core symptoms (8)
                                                          • Functional impact of core symptoms (9)
                                                          • Subtypes of ADHD
                                                          • Subtypes of ADHD (2)
                                                          • Common comorbidities with ADHD
                                                          • Slide 63
                                                          • Common comorbidities with ADHD (2)
                                                          • ADHD and girls
                                                          • Slide 66
                                                          • Slide 67
                                                          • ADHD and women
                                                          • Slide 69
                                                          • ADHD and women (2)
                                                          • Executive Functioning An Overarching Theme
                                                          • The Executive Functions
                                                          • The Executive Functions (2)
                                                          • Slide 74
                                                          • Slide 75
                                                          • Appropriate expectations
                                                          • Age-appropriate expectations
                                                          • Age-appropriate expectations (2)
                                                          • Age-appropriate expectations (3)
                                                          • Age-appropriate expectations (4)
                                                          • Age-appropriate expectations (5)
                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                          • Slide 84
                                                          • Slide 85
                                                          • Strategies (3)
                                                          • Pharmacotherapy
                                                          • Behavioral Supports
                                                          • Slide 89
                                                          • Slide 90
                                                          • Slide 91
                                                          • Slide 92
                                                          • Slide 93
                                                          • Slide 94
                                                          • Slide 95
                                                          • Slide 96
                                                          • Slide 97
                                                          • Slide 98
                                                          • Slide 99
                                                          • Slide 100
                                                          • Slide 101
                                                          • Slide 102
                                                          • Slide 103
                                                          • Slide 104
                                                          • Slide 105
                                                          • Slide 106
                                                          • Slide 107
                                                          • Slide 108
                                                          • Slide 109
                                                          • Slide 110
                                                          • Time Out
                                                          • Token economy
                                                          • Slide 113
                                                          • Slide 114
                                                          • Slide 115
                                                          • Intrinsic motivation
                                                          • Slide 117
                                                          • Slide 118
                                                          • Slide 119
                                                          • Metacognition
                                                          • ldquoLend Me Your Brainrdquo
                                                          • What Does Dopamine Feel Like
                                                          • Preferred States What Does Dopamine Feel Like
                                                          • Slide 124
                                                          • PREFERRED STATES INVENTORY
                                                          • PREFERRED STATES INVENTORY (2)
                                                          • PREFERRED STATES INVENTORY (3)
                                                          • Slide 128
                                                          • Slide 129
                                                          • Broaden and Build
                                                          • ldquoNeuroMalleabilityrdquo
                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                          • The reward-and-planning system
                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                          • The reward-and-planning system (2)
                                                          • Ways the reward-and-planning system can go wrong
                                                          • Ways the reward-and-planning system can go wrong (2)
                                                          • Ways the reward-and-planning system can go wrong (3)
                                                          • Ways the reward-and-planning system can go wrong (4)
                                                          • Slide 141
                                                          • Lend Me Your Brain
                                                          • Ways the reward-and-planning system can go wrong (5)
                                                          • Ways the reward-and-planning system can go wrong (6)
                                                          • Ways the reward-and-planning system can go wrong (7)
                                                          • Slide 146
                                                          • Ways the reward-and-planning system can go wrong (8)
                                                          • Ways the reward-and-planning system can go wrong (9)
                                                          • Slide 149
                                                          • Ways the reward-and-planning system can go wrong (10)
                                                          • Ways the reward-and-planning system can go wrong (11)
                                                          • Slide 152
                                                          • Ways the reward-and-planning system can go wrong (12)
                                                          • Slide 154
                                                          • Ways the reward-and-planning system can go wrong (13)
                                                          • Ways the reward-and-planning system can go wrong (14)
                                                          • Slide 157
                                                          • Slide 158
                                                          • Slide 159
                                                          • Ways the reward-and-planning system can go wrong (15)
                                                          • Ways the reward-and-planning system can go wrong (16)
                                                          • Slide 162
                                                          • Ways the reward-and-planning system can go wrong (17)
                                                          • Slide 164
                                                          • Instant gratification vs executive gratification
                                                          • Slide 166
                                                          • Slide 167
                                                          • Slide 168
                                                          • Slide 169
                                                          • Slide 170
                                                          • Self-Talk Proficiency
                                                          • Self-Talk Proficiency (2)
                                                          • Self-Talk Proficiency (3)
                                                          • Self-Talk Proficiency (4)
                                                          • Match the Picture
                                                          • Slide 176
                                                          • Slide 177
                                                          • Distraction Delay Training
                                                          • Slide 179
                                                          • Slide 180
                                                          • Executive Estimates Training
                                                          • Learning Time
                                                          • Learning Time (2)
                                                          • Learning Time (3)
                                                          • Slide 185
                                                          • Slide 186
                                                          • Learning Time (4)
                                                          • Asking two questionshellip
                                                          • Slide 189
                                                          • Slide 190
                                                          • Key Features of Video Games
                                                          • Key Features of Video Games (2)
                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                          • Slide 194
                                                          • Slide 195
                                                          • Slide 196
                                                          • Slide 197
                                                          • Slide 198
                                                          • Slide 199
                                                          • Slide 200
                                                          • Slide 201
                                                          • Quarterly QI review
                                                          • The post-mortem
                                                          • Slide 204
                                                          • Slide 205
                                                          • Slide 206
                                                          • Slide 207
                                                          • Slide 208
                                                          • Slide 209
                                                          • Slide 210
                                                          • The ldquoBig Fiverdquo
                                                          • Slide 212
                                                          • Slide 213
                                                          • The ldquoBig Fiverdquo (2)
                                                          • Slide 215
                                                          • Slide 216
                                                          • Slide 217
                                                          • The ldquoBig Fiverdquo (3)
                                                          • The ldquoBig Fiverdquo (4)
                                                          • The ldquoBig Fiverdquo (5)
                                                          • A challengehellip
                                                          • Slide 222

                                                            Attention Deficit Hyperactivity Disorder

                                                            Increase salience

                                                            Attention Deficit Hyperactivity Disorder

                                                            (85 ndash X) x 365

                                                            ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                            Core symptoms

                                                            Inattention distractibility

                                                            Core symptoms

                                                            Hyperactivity impulsivity

                                                            hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                            mental disorder

                                                            Functional impact of core symptoms

                                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                            Functional impact of core symptoms

                                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                            Functional impact of core symptoms

                                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                            Functional impact of core symptoms

                                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                            Functional impact of core symptoms

                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                            Functional impact of core symptoms

                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                            Functional impact of core symptoms

                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                            Functional impact of core symptoms

                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                            Functional impact of core symptoms

                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                            Subtypes of ADHD

                                                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                            Subtypes of ADHD

                                                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                            Specifed

                                                            Common comorbidities with ADHD

                                                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                            processing challenges

                                                            Common comorbidities with ADHD

                                                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                            processing challenges

                                                            ADHD and girls

                                                            ADHD and women

                                                            ADHD and women

                                                            More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                            partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                            disorganization

                                                            Executive FunctioningAn Overarching Theme

                                                            Sensory Processing Disorder Central Auditory Processing

                                                            Disorder ADHD and Executive Dysfunction

                                                            The Executive Functions

                                                            Internalizing speech Previewing

                                                            Prioritizing Tempo control Inhibition

                                                            The Executive Functions

                                                            Determining salience (whatrsquos in it for me)

                                                            Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                            Appropriate expectations

                                                            Age-appropriate expectations

                                                            Preschool 1-step errands Chores with cues Basic inhibition

                                                            Age-appropriate expectations

                                                            K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                            3rd ndash 5th

                                                            Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                            Age-appropriate expectations

                                                            6th ndash 8th

                                                            complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                            Age-appropriate expectations

                                                            Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                            already made Take othersrsquo perspective

                                                            Age-appropriate expectations

                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                            Inter-connectedness of systems Cortico-striatal system for example

                                                            Strategies

                                                            Pharmacotherapy

                                                            X

                                                            Behavioral Supports

                                                            A B C

                                                            A B C

                                                            behavior

                                                            A B C

                                                            consequences

                                                            A B C

                                                            antecedent

                                                            A B C

                                                            A B C

                                                            antecedent

                                                            A B C

                                                            antecedent

                                                            easy hard

                                                            A B C

                                                            consequences

                                                            R P

                                                            +

                                                            -

                                                            R+ P+

                                                            R- P-

                                                            Time Out

                                                            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                            Token economy

                                                            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                            Intrinsic motivation

                                                            A B C

                                                            consequencesX

                                                            A B C

                                                            behavior

                                                            Metacognition

                                                            Metacognitive knowledge Metacognitive strategies

                                                            ldquoLend Me Your Brainrdquo

                                                            What Does Dopamine Feel Like

                                                            The Physiology of Motivation and Reward

                                                            Preferred States What Does Dopamine Feel Like

                                                            1 Great experience2 Kodak moment3 The feeeeling

                                                            David D Nowell PhD189 May Street

                                                            Worcester Mass 01602DrNowellcom

                                                            PREFERRED STATES INVENTORY

                                                            wwwLulucom

                                                            Identify 20 peak experiences For each peak experience identify the

                                                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                            of that moment Name it Check the 20 peak moment-feelings for

                                                            clusters groupings There will probably be 4 or 5

                                                            PREFERRED STATES INVENTORY

                                                            Find a word a label for each of the groupings

                                                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                            ldquovaluesrdquo ways that you really like to feel

                                                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                            PREFERRED STATES INVENTORY

                                                            PREFERRED STATES INVENTORY

                                                            Broaden and Build

                                                            ldquoNeuroMalleabilityrdquo

                                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                            The reward-and-planning system

                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                            The reward-and-planning system

                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                            Ways the reward-and-planning system can go wrong

                                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                            Ways the reward-and-planning system can go wrong

                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                            Ways the reward-and-planning system can go wrong

                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                            Ways the reward-and-planning system can go wrong

                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                            Lend Me Your Brain

                                                            Supporting Clients with Executive Dysfunction

                                                            Ways the reward-and-planning system can go wrong

                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                            Ways the reward-and-planning system can go wrong

                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                            Ways the reward-and-planning system can go wrong

                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                            Ways the reward-and-planning system can go wrong

                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                            Too busy with current activity

                                                            Field dependent

                                                            Ways the reward-and-planning system can go wrong

                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                            Ways the reward-and-planning system can go wrong

                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                            Ways the reward-and-planning system can go wrong

                                                            Sequence problem-solve

                                                            Ways the reward-and-planning system can go wrong

                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                            Ways the reward-and-planning system can go wrong

                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                            Ways the reward-and-planning system can go wrong

                                                            Block out distractions

                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                            - E Goldberg

                                                            Ways the reward-and-planning system can go wrong

                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                            Ways the reward-and-planning system can go wrong

                                                            Get the reward

                                                            Ways the reward-and-planning system can go wrong

                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                            Instant gratification vs

                                                            executive gratification

                                                            A B C

                                                            behaviorx

                                                            Self-Talk Proficiency

                                                            Self-Talk Proficiency

                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                            takerdquordquo

                                                            Self-Talk Proficiency

                                                            bull -ldquoHow are you going to know what you needrdquo

                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                            bull -ldquoHow will you know when you are donerdquo

                                                            Self-Talk Proficiency

                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                            thathelliprdquo

                                                            Match the Picture

                                                            Distraction Delay Training

                                                            Executive Estimates Training

                                                            X

                                                            Learning Time

                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                            Learning Time

                                                            Learning Time

                                                            Learning Time

                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                            Asking two questionshellip

                                                            Am I having fun now And is this what I set out to do

                                                            Am I having fun nowIs

                                                            this

                                                            what

                                                            I se

                                                            t out

                                                            to

                                                            do

                                                            bullYesbullYes

                                                            bullNobullYes

                                                            bullYesbullNo

                                                            bullNobullNo

                                                            Am I having fun nowIs

                                                            this

                                                            what

                                                            I se

                                                            t out

                                                            to

                                                            do

                                                            bullFunbullOn-task

                                                            bullNot funbullOn-task

                                                            bullFunbullNot on-task

                                                            bullNot funbullNot on-task

                                                            Key Features of Video Games

                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                            inappropriate behavior ndash never reverse this

                                                            Key Features of Video Games

                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                            Volkow et al 2004

                                                            Increase salience

                                                            Increase salience

                                                            Quarterly QI review

                                                            The post-mortem

                                                            Your 1 Organizational Tool

                                                            Your 1 Organizational Tool

                                                            Yoga read

                                                            Staff meeting

                                                            Planningsession

                                                            Phone calls

                                                            billing

                                                            Your 1 Organizational Tool

                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                            Your 1 Organizational Tool

                                                            Learn French

                                                            Stop smoking

                                                            Be a better spouse

                                                            The ldquoBig Fiverdquo

                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                            The ldquoBig Fiverdquo

                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                            The ldquoBig Fiverdquo

                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                            The ldquoBig Fiverdquo

                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                            The ldquoBig Fiverdquo

                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                            A CHALLENGEhellip

                                                            wwwDrNowellcom

                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                            DavidNowellSeminars

                                                            DavidNowell

                                                            • Slide 1
                                                            • hellipa challenge
                                                            • Slide 3
                                                            • Perspective of this workshophellip
                                                            • ldquoTop ndash downrdquo dysfunction
                                                            • ldquoBottom - uprdquo dysfunction
                                                            • Slide 7
                                                            • Whatrsquos the kidrsquos deal
                                                            • Overview
                                                            • This Dense Pudding
                                                            • Sensory Processing Disorder
                                                            • Slide 12
                                                            • Slide 13
                                                            • Developmental considerations
                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                            • Whatrsquos the kidrsquos deal (2)
                                                            • Slide 17
                                                            • Whatrsquos the kidrsquos deal (3)
                                                            • Slide 19
                                                            • Strategies
                                                            • Regulatory-Sensory Processing Disorders
                                                            • Slide 22
                                                            • Slide 23
                                                            • Regulatory-Sensory Processing Disorders (2)
                                                            • Slide 25
                                                            • Central Auditory Processing Disorder
                                                            • Slide 27
                                                            • Slide 28
                                                            • Slide 29
                                                            • Central Auditory Processing Disorder (2)
                                                            • Central Auditory Processing Disorder (3)
                                                            • Central Auditory Processing Disorder (4)
                                                            • CAPD or ADHD
                                                            • Whatrsquos the kidrsquos deal (4)
                                                            • Slide 35
                                                            • Strategies (2)
                                                            • (C)APD
                                                            • Treatment for CAPD
                                                            • Treatment for CAPD (2)
                                                            • Self-assessment
                                                            • Attention Deficit Hyperactivity Disorder
                                                            • Slide 42
                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                            • (85 ndash X) x 365
                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                            • Core symptoms
                                                            • Core symptoms (2)
                                                            • hellipand the rest of the criteria
                                                            • Slide 49
                                                            • Functional impact of core symptoms
                                                            • Functional impact of core symptoms (2)
                                                            • Functional impact of core symptoms (3)
                                                            • Slide 53
                                                            • Functional impact of core symptoms (4)
                                                            • Functional impact of core symptoms (5)
                                                            • Functional impact of core symptoms (6)
                                                            • Functional impact of core symptoms (7)
                                                            • Functional impact of core symptoms (8)
                                                            • Functional impact of core symptoms (9)
                                                            • Subtypes of ADHD
                                                            • Subtypes of ADHD (2)
                                                            • Common comorbidities with ADHD
                                                            • Slide 63
                                                            • Common comorbidities with ADHD (2)
                                                            • ADHD and girls
                                                            • Slide 66
                                                            • Slide 67
                                                            • ADHD and women
                                                            • Slide 69
                                                            • ADHD and women (2)
                                                            • Executive Functioning An Overarching Theme
                                                            • The Executive Functions
                                                            • The Executive Functions (2)
                                                            • Slide 74
                                                            • Slide 75
                                                            • Appropriate expectations
                                                            • Age-appropriate expectations
                                                            • Age-appropriate expectations (2)
                                                            • Age-appropriate expectations (3)
                                                            • Age-appropriate expectations (4)
                                                            • Age-appropriate expectations (5)
                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                            • Slide 84
                                                            • Slide 85
                                                            • Strategies (3)
                                                            • Pharmacotherapy
                                                            • Behavioral Supports
                                                            • Slide 89
                                                            • Slide 90
                                                            • Slide 91
                                                            • Slide 92
                                                            • Slide 93
                                                            • Slide 94
                                                            • Slide 95
                                                            • Slide 96
                                                            • Slide 97
                                                            • Slide 98
                                                            • Slide 99
                                                            • Slide 100
                                                            • Slide 101
                                                            • Slide 102
                                                            • Slide 103
                                                            • Slide 104
                                                            • Slide 105
                                                            • Slide 106
                                                            • Slide 107
                                                            • Slide 108
                                                            • Slide 109
                                                            • Slide 110
                                                            • Time Out
                                                            • Token economy
                                                            • Slide 113
                                                            • Slide 114
                                                            • Slide 115
                                                            • Intrinsic motivation
                                                            • Slide 117
                                                            • Slide 118
                                                            • Slide 119
                                                            • Metacognition
                                                            • ldquoLend Me Your Brainrdquo
                                                            • What Does Dopamine Feel Like
                                                            • Preferred States What Does Dopamine Feel Like
                                                            • Slide 124
                                                            • PREFERRED STATES INVENTORY
                                                            • PREFERRED STATES INVENTORY (2)
                                                            • PREFERRED STATES INVENTORY (3)
                                                            • Slide 128
                                                            • Slide 129
                                                            • Broaden and Build
                                                            • ldquoNeuroMalleabilityrdquo
                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                            • The reward-and-planning system
                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                            • The reward-and-planning system (2)
                                                            • Ways the reward-and-planning system can go wrong
                                                            • Ways the reward-and-planning system can go wrong (2)
                                                            • Ways the reward-and-planning system can go wrong (3)
                                                            • Ways the reward-and-planning system can go wrong (4)
                                                            • Slide 141
                                                            • Lend Me Your Brain
                                                            • Ways the reward-and-planning system can go wrong (5)
                                                            • Ways the reward-and-planning system can go wrong (6)
                                                            • Ways the reward-and-planning system can go wrong (7)
                                                            • Slide 146
                                                            • Ways the reward-and-planning system can go wrong (8)
                                                            • Ways the reward-and-planning system can go wrong (9)
                                                            • Slide 149
                                                            • Ways the reward-and-planning system can go wrong (10)
                                                            • Ways the reward-and-planning system can go wrong (11)
                                                            • Slide 152
                                                            • Ways the reward-and-planning system can go wrong (12)
                                                            • Slide 154
                                                            • Ways the reward-and-planning system can go wrong (13)
                                                            • Ways the reward-and-planning system can go wrong (14)
                                                            • Slide 157
                                                            • Slide 158
                                                            • Slide 159
                                                            • Ways the reward-and-planning system can go wrong (15)
                                                            • Ways the reward-and-planning system can go wrong (16)
                                                            • Slide 162
                                                            • Ways the reward-and-planning system can go wrong (17)
                                                            • Slide 164
                                                            • Instant gratification vs executive gratification
                                                            • Slide 166
                                                            • Slide 167
                                                            • Slide 168
                                                            • Slide 169
                                                            • Slide 170
                                                            • Self-Talk Proficiency
                                                            • Self-Talk Proficiency (2)
                                                            • Self-Talk Proficiency (3)
                                                            • Self-Talk Proficiency (4)
                                                            • Match the Picture
                                                            • Slide 176
                                                            • Slide 177
                                                            • Distraction Delay Training
                                                            • Slide 179
                                                            • Slide 180
                                                            • Executive Estimates Training
                                                            • Learning Time
                                                            • Learning Time (2)
                                                            • Learning Time (3)
                                                            • Slide 185
                                                            • Slide 186
                                                            • Learning Time (4)
                                                            • Asking two questionshellip
                                                            • Slide 189
                                                            • Slide 190
                                                            • Key Features of Video Games
                                                            • Key Features of Video Games (2)
                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                            • Slide 194
                                                            • Slide 195
                                                            • Slide 196
                                                            • Slide 197
                                                            • Slide 198
                                                            • Slide 199
                                                            • Slide 200
                                                            • Slide 201
                                                            • Quarterly QI review
                                                            • The post-mortem
                                                            • Slide 204
                                                            • Slide 205
                                                            • Slide 206
                                                            • Slide 207
                                                            • Slide 208
                                                            • Slide 209
                                                            • Slide 210
                                                            • The ldquoBig Fiverdquo
                                                            • Slide 212
                                                            • Slide 213
                                                            • The ldquoBig Fiverdquo (2)
                                                            • Slide 215
                                                            • Slide 216
                                                            • Slide 217
                                                            • The ldquoBig Fiverdquo (3)
                                                            • The ldquoBig Fiverdquo (4)
                                                            • The ldquoBig Fiverdquo (5)
                                                            • A challengehellip
                                                            • Slide 222

                                                              Increase salience

                                                              Attention Deficit Hyperactivity Disorder

                                                              (85 ndash X) x 365

                                                              ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                              Core symptoms

                                                              Inattention distractibility

                                                              Core symptoms

                                                              Hyperactivity impulsivity

                                                              hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                              mental disorder

                                                              Functional impact of core symptoms

                                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                              Functional impact of core symptoms

                                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                              Functional impact of core symptoms

                                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                              Functional impact of core symptoms

                                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                              Functional impact of core symptoms

                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                              Functional impact of core symptoms

                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                              Functional impact of core symptoms

                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                              Functional impact of core symptoms

                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                              Functional impact of core symptoms

                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                              Subtypes of ADHD

                                                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                              Subtypes of ADHD

                                                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                              Specifed

                                                              Common comorbidities with ADHD

                                                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                              processing challenges

                                                              Common comorbidities with ADHD

                                                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                              processing challenges

                                                              ADHD and girls

                                                              ADHD and women

                                                              ADHD and women

                                                              More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                              partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                              disorganization

                                                              Executive FunctioningAn Overarching Theme

                                                              Sensory Processing Disorder Central Auditory Processing

                                                              Disorder ADHD and Executive Dysfunction

                                                              The Executive Functions

                                                              Internalizing speech Previewing

                                                              Prioritizing Tempo control Inhibition

                                                              The Executive Functions

                                                              Determining salience (whatrsquos in it for me)

                                                              Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                              Appropriate expectations

                                                              Age-appropriate expectations

                                                              Preschool 1-step errands Chores with cues Basic inhibition

                                                              Age-appropriate expectations

                                                              K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                              3rd ndash 5th

                                                              Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                              Age-appropriate expectations

                                                              6th ndash 8th

                                                              complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                              Age-appropriate expectations

                                                              Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                              already made Take othersrsquo perspective

                                                              Age-appropriate expectations

                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                              Inter-connectedness of systems Cortico-striatal system for example

                                                              Strategies

                                                              Pharmacotherapy

                                                              X

                                                              Behavioral Supports

                                                              A B C

                                                              A B C

                                                              behavior

                                                              A B C

                                                              consequences

                                                              A B C

                                                              antecedent

                                                              A B C

                                                              A B C

                                                              antecedent

                                                              A B C

                                                              antecedent

                                                              easy hard

                                                              A B C

                                                              consequences

                                                              R P

                                                              +

                                                              -

                                                              R+ P+

                                                              R- P-

                                                              Time Out

                                                              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                              Token economy

                                                              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                              Intrinsic motivation

                                                              A B C

                                                              consequencesX

                                                              A B C

                                                              behavior

                                                              Metacognition

                                                              Metacognitive knowledge Metacognitive strategies

                                                              ldquoLend Me Your Brainrdquo

                                                              What Does Dopamine Feel Like

                                                              The Physiology of Motivation and Reward

                                                              Preferred States What Does Dopamine Feel Like

                                                              1 Great experience2 Kodak moment3 The feeeeling

                                                              David D Nowell PhD189 May Street

                                                              Worcester Mass 01602DrNowellcom

                                                              PREFERRED STATES INVENTORY

                                                              wwwLulucom

                                                              Identify 20 peak experiences For each peak experience identify the

                                                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                              of that moment Name it Check the 20 peak moment-feelings for

                                                              clusters groupings There will probably be 4 or 5

                                                              PREFERRED STATES INVENTORY

                                                              Find a word a label for each of the groupings

                                                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                              ldquovaluesrdquo ways that you really like to feel

                                                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                              PREFERRED STATES INVENTORY

                                                              PREFERRED STATES INVENTORY

                                                              Broaden and Build

                                                              ldquoNeuroMalleabilityrdquo

                                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                              The reward-and-planning system

                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                              The reward-and-planning system

                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                              Ways the reward-and-planning system can go wrong

                                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                              Ways the reward-and-planning system can go wrong

                                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                              Ways the reward-and-planning system can go wrong

                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                              Ways the reward-and-planning system can go wrong

                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                              Lend Me Your Brain

                                                              Supporting Clients with Executive Dysfunction

                                                              Ways the reward-and-planning system can go wrong

                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                              Ways the reward-and-planning system can go wrong

                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                              Ways the reward-and-planning system can go wrong

                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                              Ways the reward-and-planning system can go wrong

                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                              Too busy with current activity

                                                              Field dependent

                                                              Ways the reward-and-planning system can go wrong

                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                              Ways the reward-and-planning system can go wrong

                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                              Ways the reward-and-planning system can go wrong

                                                              Sequence problem-solve

                                                              Ways the reward-and-planning system can go wrong

                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                              Ways the reward-and-planning system can go wrong

                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                              Ways the reward-and-planning system can go wrong

                                                              Block out distractions

                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                              - E Goldberg

                                                              Ways the reward-and-planning system can go wrong

                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                              Ways the reward-and-planning system can go wrong

                                                              Get the reward

                                                              Ways the reward-and-planning system can go wrong

                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                              Instant gratification vs

                                                              executive gratification

                                                              A B C

                                                              behaviorx

                                                              Self-Talk Proficiency

                                                              Self-Talk Proficiency

                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                              takerdquordquo

                                                              Self-Talk Proficiency

                                                              bull -ldquoHow are you going to know what you needrdquo

                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                              bull -ldquoHow will you know when you are donerdquo

                                                              Self-Talk Proficiency

                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                              thathelliprdquo

                                                              Match the Picture

                                                              Distraction Delay Training

                                                              Executive Estimates Training

                                                              X

                                                              Learning Time

                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                              Learning Time

                                                              Learning Time

                                                              Learning Time

                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                              Asking two questionshellip

                                                              Am I having fun now And is this what I set out to do

                                                              Am I having fun nowIs

                                                              this

                                                              what

                                                              I se

                                                              t out

                                                              to

                                                              do

                                                              bullYesbullYes

                                                              bullNobullYes

                                                              bullYesbullNo

                                                              bullNobullNo

                                                              Am I having fun nowIs

                                                              this

                                                              what

                                                              I se

                                                              t out

                                                              to

                                                              do

                                                              bullFunbullOn-task

                                                              bullNot funbullOn-task

                                                              bullFunbullNot on-task

                                                              bullNot funbullNot on-task

                                                              Key Features of Video Games

                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                              inappropriate behavior ndash never reverse this

                                                              Key Features of Video Games

                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                              Volkow et al 2004

                                                              Increase salience

                                                              Increase salience

                                                              Quarterly QI review

                                                              The post-mortem

                                                              Your 1 Organizational Tool

                                                              Your 1 Organizational Tool

                                                              Yoga read

                                                              Staff meeting

                                                              Planningsession

                                                              Phone calls

                                                              billing

                                                              Your 1 Organizational Tool

                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                              Your 1 Organizational Tool

                                                              Learn French

                                                              Stop smoking

                                                              Be a better spouse

                                                              The ldquoBig Fiverdquo

                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                              The ldquoBig Fiverdquo

                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                              The ldquoBig Fiverdquo

                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                              The ldquoBig Fiverdquo

                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                              The ldquoBig Fiverdquo

                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                              A CHALLENGEhellip

                                                              wwwDrNowellcom

                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                              DavidNowellSeminars

                                                              DavidNowell

                                                              • Slide 1
                                                              • hellipa challenge
                                                              • Slide 3
                                                              • Perspective of this workshophellip
                                                              • ldquoTop ndash downrdquo dysfunction
                                                              • ldquoBottom - uprdquo dysfunction
                                                              • Slide 7
                                                              • Whatrsquos the kidrsquos deal
                                                              • Overview
                                                              • This Dense Pudding
                                                              • Sensory Processing Disorder
                                                              • Slide 12
                                                              • Slide 13
                                                              • Developmental considerations
                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                              • Whatrsquos the kidrsquos deal (2)
                                                              • Slide 17
                                                              • Whatrsquos the kidrsquos deal (3)
                                                              • Slide 19
                                                              • Strategies
                                                              • Regulatory-Sensory Processing Disorders
                                                              • Slide 22
                                                              • Slide 23
                                                              • Regulatory-Sensory Processing Disorders (2)
                                                              • Slide 25
                                                              • Central Auditory Processing Disorder
                                                              • Slide 27
                                                              • Slide 28
                                                              • Slide 29
                                                              • Central Auditory Processing Disorder (2)
                                                              • Central Auditory Processing Disorder (3)
                                                              • Central Auditory Processing Disorder (4)
                                                              • CAPD or ADHD
                                                              • Whatrsquos the kidrsquos deal (4)
                                                              • Slide 35
                                                              • Strategies (2)
                                                              • (C)APD
                                                              • Treatment for CAPD
                                                              • Treatment for CAPD (2)
                                                              • Self-assessment
                                                              • Attention Deficit Hyperactivity Disorder
                                                              • Slide 42
                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                              • (85 ndash X) x 365
                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                              • Core symptoms
                                                              • Core symptoms (2)
                                                              • hellipand the rest of the criteria
                                                              • Slide 49
                                                              • Functional impact of core symptoms
                                                              • Functional impact of core symptoms (2)
                                                              • Functional impact of core symptoms (3)
                                                              • Slide 53
                                                              • Functional impact of core symptoms (4)
                                                              • Functional impact of core symptoms (5)
                                                              • Functional impact of core symptoms (6)
                                                              • Functional impact of core symptoms (7)
                                                              • Functional impact of core symptoms (8)
                                                              • Functional impact of core symptoms (9)
                                                              • Subtypes of ADHD
                                                              • Subtypes of ADHD (2)
                                                              • Common comorbidities with ADHD
                                                              • Slide 63
                                                              • Common comorbidities with ADHD (2)
                                                              • ADHD and girls
                                                              • Slide 66
                                                              • Slide 67
                                                              • ADHD and women
                                                              • Slide 69
                                                              • ADHD and women (2)
                                                              • Executive Functioning An Overarching Theme
                                                              • The Executive Functions
                                                              • The Executive Functions (2)
                                                              • Slide 74
                                                              • Slide 75
                                                              • Appropriate expectations
                                                              • Age-appropriate expectations
                                                              • Age-appropriate expectations (2)
                                                              • Age-appropriate expectations (3)
                                                              • Age-appropriate expectations (4)
                                                              • Age-appropriate expectations (5)
                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                              • Slide 84
                                                              • Slide 85
                                                              • Strategies (3)
                                                              • Pharmacotherapy
                                                              • Behavioral Supports
                                                              • Slide 89
                                                              • Slide 90
                                                              • Slide 91
                                                              • Slide 92
                                                              • Slide 93
                                                              • Slide 94
                                                              • Slide 95
                                                              • Slide 96
                                                              • Slide 97
                                                              • Slide 98
                                                              • Slide 99
                                                              • Slide 100
                                                              • Slide 101
                                                              • Slide 102
                                                              • Slide 103
                                                              • Slide 104
                                                              • Slide 105
                                                              • Slide 106
                                                              • Slide 107
                                                              • Slide 108
                                                              • Slide 109
                                                              • Slide 110
                                                              • Time Out
                                                              • Token economy
                                                              • Slide 113
                                                              • Slide 114
                                                              • Slide 115
                                                              • Intrinsic motivation
                                                              • Slide 117
                                                              • Slide 118
                                                              • Slide 119
                                                              • Metacognition
                                                              • ldquoLend Me Your Brainrdquo
                                                              • What Does Dopamine Feel Like
                                                              • Preferred States What Does Dopamine Feel Like
                                                              • Slide 124
                                                              • PREFERRED STATES INVENTORY
                                                              • PREFERRED STATES INVENTORY (2)
                                                              • PREFERRED STATES INVENTORY (3)
                                                              • Slide 128
                                                              • Slide 129
                                                              • Broaden and Build
                                                              • ldquoNeuroMalleabilityrdquo
                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                              • The reward-and-planning system
                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                              • The reward-and-planning system (2)
                                                              • Ways the reward-and-planning system can go wrong
                                                              • Ways the reward-and-planning system can go wrong (2)
                                                              • Ways the reward-and-planning system can go wrong (3)
                                                              • Ways the reward-and-planning system can go wrong (4)
                                                              • Slide 141
                                                              • Lend Me Your Brain
                                                              • Ways the reward-and-planning system can go wrong (5)
                                                              • Ways the reward-and-planning system can go wrong (6)
                                                              • Ways the reward-and-planning system can go wrong (7)
                                                              • Slide 146
                                                              • Ways the reward-and-planning system can go wrong (8)
                                                              • Ways the reward-and-planning system can go wrong (9)
                                                              • Slide 149
                                                              • Ways the reward-and-planning system can go wrong (10)
                                                              • Ways the reward-and-planning system can go wrong (11)
                                                              • Slide 152
                                                              • Ways the reward-and-planning system can go wrong (12)
                                                              • Slide 154
                                                              • Ways the reward-and-planning system can go wrong (13)
                                                              • Ways the reward-and-planning system can go wrong (14)
                                                              • Slide 157
                                                              • Slide 158
                                                              • Slide 159
                                                              • Ways the reward-and-planning system can go wrong (15)
                                                              • Ways the reward-and-planning system can go wrong (16)
                                                              • Slide 162
                                                              • Ways the reward-and-planning system can go wrong (17)
                                                              • Slide 164
                                                              • Instant gratification vs executive gratification
                                                              • Slide 166
                                                              • Slide 167
                                                              • Slide 168
                                                              • Slide 169
                                                              • Slide 170
                                                              • Self-Talk Proficiency
                                                              • Self-Talk Proficiency (2)
                                                              • Self-Talk Proficiency (3)
                                                              • Self-Talk Proficiency (4)
                                                              • Match the Picture
                                                              • Slide 176
                                                              • Slide 177
                                                              • Distraction Delay Training
                                                              • Slide 179
                                                              • Slide 180
                                                              • Executive Estimates Training
                                                              • Learning Time
                                                              • Learning Time (2)
                                                              • Learning Time (3)
                                                              • Slide 185
                                                              • Slide 186
                                                              • Learning Time (4)
                                                              • Asking two questionshellip
                                                              • Slide 189
                                                              • Slide 190
                                                              • Key Features of Video Games
                                                              • Key Features of Video Games (2)
                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                              • Slide 194
                                                              • Slide 195
                                                              • Slide 196
                                                              • Slide 197
                                                              • Slide 198
                                                              • Slide 199
                                                              • Slide 200
                                                              • Slide 201
                                                              • Quarterly QI review
                                                              • The post-mortem
                                                              • Slide 204
                                                              • Slide 205
                                                              • Slide 206
                                                              • Slide 207
                                                              • Slide 208
                                                              • Slide 209
                                                              • Slide 210
                                                              • The ldquoBig Fiverdquo
                                                              • Slide 212
                                                              • Slide 213
                                                              • The ldquoBig Fiverdquo (2)
                                                              • Slide 215
                                                              • Slide 216
                                                              • Slide 217
                                                              • The ldquoBig Fiverdquo (3)
                                                              • The ldquoBig Fiverdquo (4)
                                                              • The ldquoBig Fiverdquo (5)
                                                              • A challengehellip
                                                              • Slide 222

                                                                Attention Deficit Hyperactivity Disorder

                                                                (85 ndash X) x 365

                                                                ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                                Core symptoms

                                                                Inattention distractibility

                                                                Core symptoms

                                                                Hyperactivity impulsivity

                                                                hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                                mental disorder

                                                                Functional impact of core symptoms

                                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                Functional impact of core symptoms

                                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                Functional impact of core symptoms

                                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                Functional impact of core symptoms

                                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                Functional impact of core symptoms

                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                Functional impact of core symptoms

                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                Functional impact of core symptoms

                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                Functional impact of core symptoms

                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                Functional impact of core symptoms

                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                Subtypes of ADHD

                                                                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                Subtypes of ADHD

                                                                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                Specifed

                                                                Common comorbidities with ADHD

                                                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                processing challenges

                                                                Common comorbidities with ADHD

                                                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                processing challenges

                                                                ADHD and girls

                                                                ADHD and women

                                                                ADHD and women

                                                                More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                disorganization

                                                                Executive FunctioningAn Overarching Theme

                                                                Sensory Processing Disorder Central Auditory Processing

                                                                Disorder ADHD and Executive Dysfunction

                                                                The Executive Functions

                                                                Internalizing speech Previewing

                                                                Prioritizing Tempo control Inhibition

                                                                The Executive Functions

                                                                Determining salience (whatrsquos in it for me)

                                                                Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                Appropriate expectations

                                                                Age-appropriate expectations

                                                                Preschool 1-step errands Chores with cues Basic inhibition

                                                                Age-appropriate expectations

                                                                K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                3rd ndash 5th

                                                                Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                Age-appropriate expectations

                                                                6th ndash 8th

                                                                complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                Age-appropriate expectations

                                                                Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                already made Take othersrsquo perspective

                                                                Age-appropriate expectations

                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                Inter-connectedness of systems Cortico-striatal system for example

                                                                Strategies

                                                                Pharmacotherapy

                                                                X

                                                                Behavioral Supports

                                                                A B C

                                                                A B C

                                                                behavior

                                                                A B C

                                                                consequences

                                                                A B C

                                                                antecedent

                                                                A B C

                                                                A B C

                                                                antecedent

                                                                A B C

                                                                antecedent

                                                                easy hard

                                                                A B C

                                                                consequences

                                                                R P

                                                                +

                                                                -

                                                                R+ P+

                                                                R- P-

                                                                Time Out

                                                                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                Token economy

                                                                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                Intrinsic motivation

                                                                A B C

                                                                consequencesX

                                                                A B C

                                                                behavior

                                                                Metacognition

                                                                Metacognitive knowledge Metacognitive strategies

                                                                ldquoLend Me Your Brainrdquo

                                                                What Does Dopamine Feel Like

                                                                The Physiology of Motivation and Reward

                                                                Preferred States What Does Dopamine Feel Like

                                                                1 Great experience2 Kodak moment3 The feeeeling

                                                                David D Nowell PhD189 May Street

                                                                Worcester Mass 01602DrNowellcom

                                                                PREFERRED STATES INVENTORY

                                                                wwwLulucom

                                                                Identify 20 peak experiences For each peak experience identify the

                                                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                of that moment Name it Check the 20 peak moment-feelings for

                                                                clusters groupings There will probably be 4 or 5

                                                                PREFERRED STATES INVENTORY

                                                                Find a word a label for each of the groupings

                                                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                ldquovaluesrdquo ways that you really like to feel

                                                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                PREFERRED STATES INVENTORY

                                                                PREFERRED STATES INVENTORY

                                                                Broaden and Build

                                                                ldquoNeuroMalleabilityrdquo

                                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                The reward-and-planning system

                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                The reward-and-planning system

                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                Ways the reward-and-planning system can go wrong

                                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                Ways the reward-and-planning system can go wrong

                                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                Ways the reward-and-planning system can go wrong

                                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                Ways the reward-and-planning system can go wrong

                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                Lend Me Your Brain

                                                                Supporting Clients with Executive Dysfunction

                                                                Ways the reward-and-planning system can go wrong

                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                Ways the reward-and-planning system can go wrong

                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                Ways the reward-and-planning system can go wrong

                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                Ways the reward-and-planning system can go wrong

                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                Too busy with current activity

                                                                Field dependent

                                                                Ways the reward-and-planning system can go wrong

                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                Ways the reward-and-planning system can go wrong

                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                Ways the reward-and-planning system can go wrong

                                                                Sequence problem-solve

                                                                Ways the reward-and-planning system can go wrong

                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                Ways the reward-and-planning system can go wrong

                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                Ways the reward-and-planning system can go wrong

                                                                Block out distractions

                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                - E Goldberg

                                                                Ways the reward-and-planning system can go wrong

                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                Ways the reward-and-planning system can go wrong

                                                                Get the reward

                                                                Ways the reward-and-planning system can go wrong

                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                Instant gratification vs

                                                                executive gratification

                                                                A B C

                                                                behaviorx

                                                                Self-Talk Proficiency

                                                                Self-Talk Proficiency

                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                takerdquordquo

                                                                Self-Talk Proficiency

                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                bull -ldquoHow will you know when you are donerdquo

                                                                Self-Talk Proficiency

                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                thathelliprdquo

                                                                Match the Picture

                                                                Distraction Delay Training

                                                                Executive Estimates Training

                                                                X

                                                                Learning Time

                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                Learning Time

                                                                Learning Time

                                                                Learning Time

                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                Asking two questionshellip

                                                                Am I having fun now And is this what I set out to do

                                                                Am I having fun nowIs

                                                                this

                                                                what

                                                                I se

                                                                t out

                                                                to

                                                                do

                                                                bullYesbullYes

                                                                bullNobullYes

                                                                bullYesbullNo

                                                                bullNobullNo

                                                                Am I having fun nowIs

                                                                this

                                                                what

                                                                I se

                                                                t out

                                                                to

                                                                do

                                                                bullFunbullOn-task

                                                                bullNot funbullOn-task

                                                                bullFunbullNot on-task

                                                                bullNot funbullNot on-task

                                                                Key Features of Video Games

                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                inappropriate behavior ndash never reverse this

                                                                Key Features of Video Games

                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                Volkow et al 2004

                                                                Increase salience

                                                                Increase salience

                                                                Quarterly QI review

                                                                The post-mortem

                                                                Your 1 Organizational Tool

                                                                Your 1 Organizational Tool

                                                                Yoga read

                                                                Staff meeting

                                                                Planningsession

                                                                Phone calls

                                                                billing

                                                                Your 1 Organizational Tool

                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                Your 1 Organizational Tool

                                                                Learn French

                                                                Stop smoking

                                                                Be a better spouse

                                                                The ldquoBig Fiverdquo

                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                The ldquoBig Fiverdquo

                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                The ldquoBig Fiverdquo

                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                The ldquoBig Fiverdquo

                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                The ldquoBig Fiverdquo

                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                A CHALLENGEhellip

                                                                wwwDrNowellcom

                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                DavidNowellSeminars

                                                                DavidNowell

                                                                • Slide 1
                                                                • hellipa challenge
                                                                • Slide 3
                                                                • Perspective of this workshophellip
                                                                • ldquoTop ndash downrdquo dysfunction
                                                                • ldquoBottom - uprdquo dysfunction
                                                                • Slide 7
                                                                • Whatrsquos the kidrsquos deal
                                                                • Overview
                                                                • This Dense Pudding
                                                                • Sensory Processing Disorder
                                                                • Slide 12
                                                                • Slide 13
                                                                • Developmental considerations
                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                • Whatrsquos the kidrsquos deal (2)
                                                                • Slide 17
                                                                • Whatrsquos the kidrsquos deal (3)
                                                                • Slide 19
                                                                • Strategies
                                                                • Regulatory-Sensory Processing Disorders
                                                                • Slide 22
                                                                • Slide 23
                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                • Slide 25
                                                                • Central Auditory Processing Disorder
                                                                • Slide 27
                                                                • Slide 28
                                                                • Slide 29
                                                                • Central Auditory Processing Disorder (2)
                                                                • Central Auditory Processing Disorder (3)
                                                                • Central Auditory Processing Disorder (4)
                                                                • CAPD or ADHD
                                                                • Whatrsquos the kidrsquos deal (4)
                                                                • Slide 35
                                                                • Strategies (2)
                                                                • (C)APD
                                                                • Treatment for CAPD
                                                                • Treatment for CAPD (2)
                                                                • Self-assessment
                                                                • Attention Deficit Hyperactivity Disorder
                                                                • Slide 42
                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                • (85 ndash X) x 365
                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                • Core symptoms
                                                                • Core symptoms (2)
                                                                • hellipand the rest of the criteria
                                                                • Slide 49
                                                                • Functional impact of core symptoms
                                                                • Functional impact of core symptoms (2)
                                                                • Functional impact of core symptoms (3)
                                                                • Slide 53
                                                                • Functional impact of core symptoms (4)
                                                                • Functional impact of core symptoms (5)
                                                                • Functional impact of core symptoms (6)
                                                                • Functional impact of core symptoms (7)
                                                                • Functional impact of core symptoms (8)
                                                                • Functional impact of core symptoms (9)
                                                                • Subtypes of ADHD
                                                                • Subtypes of ADHD (2)
                                                                • Common comorbidities with ADHD
                                                                • Slide 63
                                                                • Common comorbidities with ADHD (2)
                                                                • ADHD and girls
                                                                • Slide 66
                                                                • Slide 67
                                                                • ADHD and women
                                                                • Slide 69
                                                                • ADHD and women (2)
                                                                • Executive Functioning An Overarching Theme
                                                                • The Executive Functions
                                                                • The Executive Functions (2)
                                                                • Slide 74
                                                                • Slide 75
                                                                • Appropriate expectations
                                                                • Age-appropriate expectations
                                                                • Age-appropriate expectations (2)
                                                                • Age-appropriate expectations (3)
                                                                • Age-appropriate expectations (4)
                                                                • Age-appropriate expectations (5)
                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                • Slide 84
                                                                • Slide 85
                                                                • Strategies (3)
                                                                • Pharmacotherapy
                                                                • Behavioral Supports
                                                                • Slide 89
                                                                • Slide 90
                                                                • Slide 91
                                                                • Slide 92
                                                                • Slide 93
                                                                • Slide 94
                                                                • Slide 95
                                                                • Slide 96
                                                                • Slide 97
                                                                • Slide 98
                                                                • Slide 99
                                                                • Slide 100
                                                                • Slide 101
                                                                • Slide 102
                                                                • Slide 103
                                                                • Slide 104
                                                                • Slide 105
                                                                • Slide 106
                                                                • Slide 107
                                                                • Slide 108
                                                                • Slide 109
                                                                • Slide 110
                                                                • Time Out
                                                                • Token economy
                                                                • Slide 113
                                                                • Slide 114
                                                                • Slide 115
                                                                • Intrinsic motivation
                                                                • Slide 117
                                                                • Slide 118
                                                                • Slide 119
                                                                • Metacognition
                                                                • ldquoLend Me Your Brainrdquo
                                                                • What Does Dopamine Feel Like
                                                                • Preferred States What Does Dopamine Feel Like
                                                                • Slide 124
                                                                • PREFERRED STATES INVENTORY
                                                                • PREFERRED STATES INVENTORY (2)
                                                                • PREFERRED STATES INVENTORY (3)
                                                                • Slide 128
                                                                • Slide 129
                                                                • Broaden and Build
                                                                • ldquoNeuroMalleabilityrdquo
                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                • The reward-and-planning system
                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                • The reward-and-planning system (2)
                                                                • Ways the reward-and-planning system can go wrong
                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                • Slide 141
                                                                • Lend Me Your Brain
                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                • Slide 146
                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                • Slide 149
                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                • Slide 152
                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                • Slide 154
                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                • Slide 157
                                                                • Slide 158
                                                                • Slide 159
                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                • Slide 162
                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                • Slide 164
                                                                • Instant gratification vs executive gratification
                                                                • Slide 166
                                                                • Slide 167
                                                                • Slide 168
                                                                • Slide 169
                                                                • Slide 170
                                                                • Self-Talk Proficiency
                                                                • Self-Talk Proficiency (2)
                                                                • Self-Talk Proficiency (3)
                                                                • Self-Talk Proficiency (4)
                                                                • Match the Picture
                                                                • Slide 176
                                                                • Slide 177
                                                                • Distraction Delay Training
                                                                • Slide 179
                                                                • Slide 180
                                                                • Executive Estimates Training
                                                                • Learning Time
                                                                • Learning Time (2)
                                                                • Learning Time (3)
                                                                • Slide 185
                                                                • Slide 186
                                                                • Learning Time (4)
                                                                • Asking two questionshellip
                                                                • Slide 189
                                                                • Slide 190
                                                                • Key Features of Video Games
                                                                • Key Features of Video Games (2)
                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                • Slide 194
                                                                • Slide 195
                                                                • Slide 196
                                                                • Slide 197
                                                                • Slide 198
                                                                • Slide 199
                                                                • Slide 200
                                                                • Slide 201
                                                                • Quarterly QI review
                                                                • The post-mortem
                                                                • Slide 204
                                                                • Slide 205
                                                                • Slide 206
                                                                • Slide 207
                                                                • Slide 208
                                                                • Slide 209
                                                                • Slide 210
                                                                • The ldquoBig Fiverdquo
                                                                • Slide 212
                                                                • Slide 213
                                                                • The ldquoBig Fiverdquo (2)
                                                                • Slide 215
                                                                • Slide 216
                                                                • Slide 217
                                                                • The ldquoBig Fiverdquo (3)
                                                                • The ldquoBig Fiverdquo (4)
                                                                • The ldquoBig Fiverdquo (5)
                                                                • A challengehellip
                                                                • Slide 222

                                                                  (85 ndash X) x 365

                                                                  ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                                  Core symptoms

                                                                  Inattention distractibility

                                                                  Core symptoms

                                                                  Hyperactivity impulsivity

                                                                  hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                                  mental disorder

                                                                  Functional impact of core symptoms

                                                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                  Functional impact of core symptoms

                                                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                  Functional impact of core symptoms

                                                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                  Functional impact of core symptoms

                                                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                  Functional impact of core symptoms

                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                  Functional impact of core symptoms

                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                  Functional impact of core symptoms

                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                  Functional impact of core symptoms

                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                  Functional impact of core symptoms

                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                  Subtypes of ADHD

                                                                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                  Subtypes of ADHD

                                                                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                  Specifed

                                                                  Common comorbidities with ADHD

                                                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                  processing challenges

                                                                  Common comorbidities with ADHD

                                                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                  processing challenges

                                                                  ADHD and girls

                                                                  ADHD and women

                                                                  ADHD and women

                                                                  More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                  partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                  disorganization

                                                                  Executive FunctioningAn Overarching Theme

                                                                  Sensory Processing Disorder Central Auditory Processing

                                                                  Disorder ADHD and Executive Dysfunction

                                                                  The Executive Functions

                                                                  Internalizing speech Previewing

                                                                  Prioritizing Tempo control Inhibition

                                                                  The Executive Functions

                                                                  Determining salience (whatrsquos in it for me)

                                                                  Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                  Appropriate expectations

                                                                  Age-appropriate expectations

                                                                  Preschool 1-step errands Chores with cues Basic inhibition

                                                                  Age-appropriate expectations

                                                                  K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                  3rd ndash 5th

                                                                  Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                  Age-appropriate expectations

                                                                  6th ndash 8th

                                                                  complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                  Age-appropriate expectations

                                                                  Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                  already made Take othersrsquo perspective

                                                                  Age-appropriate expectations

                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                  Inter-connectedness of systems Cortico-striatal system for example

                                                                  Strategies

                                                                  Pharmacotherapy

                                                                  X

                                                                  Behavioral Supports

                                                                  A B C

                                                                  A B C

                                                                  behavior

                                                                  A B C

                                                                  consequences

                                                                  A B C

                                                                  antecedent

                                                                  A B C

                                                                  A B C

                                                                  antecedent

                                                                  A B C

                                                                  antecedent

                                                                  easy hard

                                                                  A B C

                                                                  consequences

                                                                  R P

                                                                  +

                                                                  -

                                                                  R+ P+

                                                                  R- P-

                                                                  Time Out

                                                                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                  Token economy

                                                                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                  Intrinsic motivation

                                                                  A B C

                                                                  consequencesX

                                                                  A B C

                                                                  behavior

                                                                  Metacognition

                                                                  Metacognitive knowledge Metacognitive strategies

                                                                  ldquoLend Me Your Brainrdquo

                                                                  What Does Dopamine Feel Like

                                                                  The Physiology of Motivation and Reward

                                                                  Preferred States What Does Dopamine Feel Like

                                                                  1 Great experience2 Kodak moment3 The feeeeling

                                                                  David D Nowell PhD189 May Street

                                                                  Worcester Mass 01602DrNowellcom

                                                                  PREFERRED STATES INVENTORY

                                                                  wwwLulucom

                                                                  Identify 20 peak experiences For each peak experience identify the

                                                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                  of that moment Name it Check the 20 peak moment-feelings for

                                                                  clusters groupings There will probably be 4 or 5

                                                                  PREFERRED STATES INVENTORY

                                                                  Find a word a label for each of the groupings

                                                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                  ldquovaluesrdquo ways that you really like to feel

                                                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                  PREFERRED STATES INVENTORY

                                                                  PREFERRED STATES INVENTORY

                                                                  Broaden and Build

                                                                  ldquoNeuroMalleabilityrdquo

                                                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                  The reward-and-planning system

                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                  The reward-and-planning system

                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                  Lend Me Your Brain

                                                                  Supporting Clients with Executive Dysfunction

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                  Too busy with current activity

                                                                  Field dependent

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Sequence problem-solve

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Block out distractions

                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                  - E Goldberg

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Get the reward

                                                                  Ways the reward-and-planning system can go wrong

                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                  Instant gratification vs

                                                                  executive gratification

                                                                  A B C

                                                                  behaviorx

                                                                  Self-Talk Proficiency

                                                                  Self-Talk Proficiency

                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                  takerdquordquo

                                                                  Self-Talk Proficiency

                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                  Self-Talk Proficiency

                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                  thathelliprdquo

                                                                  Match the Picture

                                                                  Distraction Delay Training

                                                                  Executive Estimates Training

                                                                  X

                                                                  Learning Time

                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                  Learning Time

                                                                  Learning Time

                                                                  Learning Time

                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                  Asking two questionshellip

                                                                  Am I having fun now And is this what I set out to do

                                                                  Am I having fun nowIs

                                                                  this

                                                                  what

                                                                  I se

                                                                  t out

                                                                  to

                                                                  do

                                                                  bullYesbullYes

                                                                  bullNobullYes

                                                                  bullYesbullNo

                                                                  bullNobullNo

                                                                  Am I having fun nowIs

                                                                  this

                                                                  what

                                                                  I se

                                                                  t out

                                                                  to

                                                                  do

                                                                  bullFunbullOn-task

                                                                  bullNot funbullOn-task

                                                                  bullFunbullNot on-task

                                                                  bullNot funbullNot on-task

                                                                  Key Features of Video Games

                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                  inappropriate behavior ndash never reverse this

                                                                  Key Features of Video Games

                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                  Volkow et al 2004

                                                                  Increase salience

                                                                  Increase salience

                                                                  Quarterly QI review

                                                                  The post-mortem

                                                                  Your 1 Organizational Tool

                                                                  Your 1 Organizational Tool

                                                                  Yoga read

                                                                  Staff meeting

                                                                  Planningsession

                                                                  Phone calls

                                                                  billing

                                                                  Your 1 Organizational Tool

                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                  Your 1 Organizational Tool

                                                                  Learn French

                                                                  Stop smoking

                                                                  Be a better spouse

                                                                  The ldquoBig Fiverdquo

                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                  The ldquoBig Fiverdquo

                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                  The ldquoBig Fiverdquo

                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                  The ldquoBig Fiverdquo

                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                  The ldquoBig Fiverdquo

                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                  A CHALLENGEhellip

                                                                  wwwDrNowellcom

                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                  DavidNowellSeminars

                                                                  DavidNowell

                                                                  • Slide 1
                                                                  • hellipa challenge
                                                                  • Slide 3
                                                                  • Perspective of this workshophellip
                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                  • ldquoBottom - uprdquo dysfunction
                                                                  • Slide 7
                                                                  • Whatrsquos the kidrsquos deal
                                                                  • Overview
                                                                  • This Dense Pudding
                                                                  • Sensory Processing Disorder
                                                                  • Slide 12
                                                                  • Slide 13
                                                                  • Developmental considerations
                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                  • Slide 17
                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                  • Slide 19
                                                                  • Strategies
                                                                  • Regulatory-Sensory Processing Disorders
                                                                  • Slide 22
                                                                  • Slide 23
                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                  • Slide 25
                                                                  • Central Auditory Processing Disorder
                                                                  • Slide 27
                                                                  • Slide 28
                                                                  • Slide 29
                                                                  • Central Auditory Processing Disorder (2)
                                                                  • Central Auditory Processing Disorder (3)
                                                                  • Central Auditory Processing Disorder (4)
                                                                  • CAPD or ADHD
                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                  • Slide 35
                                                                  • Strategies (2)
                                                                  • (C)APD
                                                                  • Treatment for CAPD
                                                                  • Treatment for CAPD (2)
                                                                  • Self-assessment
                                                                  • Attention Deficit Hyperactivity Disorder
                                                                  • Slide 42
                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                  • (85 ndash X) x 365
                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                  • Core symptoms
                                                                  • Core symptoms (2)
                                                                  • hellipand the rest of the criteria
                                                                  • Slide 49
                                                                  • Functional impact of core symptoms
                                                                  • Functional impact of core symptoms (2)
                                                                  • Functional impact of core symptoms (3)
                                                                  • Slide 53
                                                                  • Functional impact of core symptoms (4)
                                                                  • Functional impact of core symptoms (5)
                                                                  • Functional impact of core symptoms (6)
                                                                  • Functional impact of core symptoms (7)
                                                                  • Functional impact of core symptoms (8)
                                                                  • Functional impact of core symptoms (9)
                                                                  • Subtypes of ADHD
                                                                  • Subtypes of ADHD (2)
                                                                  • Common comorbidities with ADHD
                                                                  • Slide 63
                                                                  • Common comorbidities with ADHD (2)
                                                                  • ADHD and girls
                                                                  • Slide 66
                                                                  • Slide 67
                                                                  • ADHD and women
                                                                  • Slide 69
                                                                  • ADHD and women (2)
                                                                  • Executive Functioning An Overarching Theme
                                                                  • The Executive Functions
                                                                  • The Executive Functions (2)
                                                                  • Slide 74
                                                                  • Slide 75
                                                                  • Appropriate expectations
                                                                  • Age-appropriate expectations
                                                                  • Age-appropriate expectations (2)
                                                                  • Age-appropriate expectations (3)
                                                                  • Age-appropriate expectations (4)
                                                                  • Age-appropriate expectations (5)
                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                  • Slide 84
                                                                  • Slide 85
                                                                  • Strategies (3)
                                                                  • Pharmacotherapy
                                                                  • Behavioral Supports
                                                                  • Slide 89
                                                                  • Slide 90
                                                                  • Slide 91
                                                                  • Slide 92
                                                                  • Slide 93
                                                                  • Slide 94
                                                                  • Slide 95
                                                                  • Slide 96
                                                                  • Slide 97
                                                                  • Slide 98
                                                                  • Slide 99
                                                                  • Slide 100
                                                                  • Slide 101
                                                                  • Slide 102
                                                                  • Slide 103
                                                                  • Slide 104
                                                                  • Slide 105
                                                                  • Slide 106
                                                                  • Slide 107
                                                                  • Slide 108
                                                                  • Slide 109
                                                                  • Slide 110
                                                                  • Time Out
                                                                  • Token economy
                                                                  • Slide 113
                                                                  • Slide 114
                                                                  • Slide 115
                                                                  • Intrinsic motivation
                                                                  • Slide 117
                                                                  • Slide 118
                                                                  • Slide 119
                                                                  • Metacognition
                                                                  • ldquoLend Me Your Brainrdquo
                                                                  • What Does Dopamine Feel Like
                                                                  • Preferred States What Does Dopamine Feel Like
                                                                  • Slide 124
                                                                  • PREFERRED STATES INVENTORY
                                                                  • PREFERRED STATES INVENTORY (2)
                                                                  • PREFERRED STATES INVENTORY (3)
                                                                  • Slide 128
                                                                  • Slide 129
                                                                  • Broaden and Build
                                                                  • ldquoNeuroMalleabilityrdquo
                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                  • The reward-and-planning system
                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                  • The reward-and-planning system (2)
                                                                  • Ways the reward-and-planning system can go wrong
                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                  • Slide 141
                                                                  • Lend Me Your Brain
                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                  • Slide 146
                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                  • Slide 149
                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                  • Slide 152
                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                  • Slide 154
                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                  • Slide 157
                                                                  • Slide 158
                                                                  • Slide 159
                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                  • Slide 162
                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                  • Slide 164
                                                                  • Instant gratification vs executive gratification
                                                                  • Slide 166
                                                                  • Slide 167
                                                                  • Slide 168
                                                                  • Slide 169
                                                                  • Slide 170
                                                                  • Self-Talk Proficiency
                                                                  • Self-Talk Proficiency (2)
                                                                  • Self-Talk Proficiency (3)
                                                                  • Self-Talk Proficiency (4)
                                                                  • Match the Picture
                                                                  • Slide 176
                                                                  • Slide 177
                                                                  • Distraction Delay Training
                                                                  • Slide 179
                                                                  • Slide 180
                                                                  • Executive Estimates Training
                                                                  • Learning Time
                                                                  • Learning Time (2)
                                                                  • Learning Time (3)
                                                                  • Slide 185
                                                                  • Slide 186
                                                                  • Learning Time (4)
                                                                  • Asking two questionshellip
                                                                  • Slide 189
                                                                  • Slide 190
                                                                  • Key Features of Video Games
                                                                  • Key Features of Video Games (2)
                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                  • Slide 194
                                                                  • Slide 195
                                                                  • Slide 196
                                                                  • Slide 197
                                                                  • Slide 198
                                                                  • Slide 199
                                                                  • Slide 200
                                                                  • Slide 201
                                                                  • Quarterly QI review
                                                                  • The post-mortem
                                                                  • Slide 204
                                                                  • Slide 205
                                                                  • Slide 206
                                                                  • Slide 207
                                                                  • Slide 208
                                                                  • Slide 209
                                                                  • Slide 210
                                                                  • The ldquoBig Fiverdquo
                                                                  • Slide 212
                                                                  • Slide 213
                                                                  • The ldquoBig Fiverdquo (2)
                                                                  • Slide 215
                                                                  • Slide 216
                                                                  • Slide 217
                                                                  • The ldquoBig Fiverdquo (3)
                                                                  • The ldquoBig Fiverdquo (4)
                                                                  • The ldquoBig Fiverdquo (5)
                                                                  • A challengehellip
                                                                  • Slide 222

                                                                    ldquoIrsquom gonna eat all the gum and candy I wantrdquo

                                                                    Core symptoms

                                                                    Inattention distractibility

                                                                    Core symptoms

                                                                    Hyperactivity impulsivity

                                                                    hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                                    mental disorder

                                                                    Functional impact of core symptoms

                                                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                    Functional impact of core symptoms

                                                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                    Functional impact of core symptoms

                                                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                    Functional impact of core symptoms

                                                                    Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                    Functional impact of core symptoms

                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                    Functional impact of core symptoms

                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                    Functional impact of core symptoms

                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                    Functional impact of core symptoms

                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                    Functional impact of core symptoms

                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                    Subtypes of ADHD

                                                                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                    Subtypes of ADHD

                                                                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                    Specifed

                                                                    Common comorbidities with ADHD

                                                                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                    processing challenges

                                                                    Common comorbidities with ADHD

                                                                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                    processing challenges

                                                                    ADHD and girls

                                                                    ADHD and women

                                                                    ADHD and women

                                                                    More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                    partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                    disorganization

                                                                    Executive FunctioningAn Overarching Theme

                                                                    Sensory Processing Disorder Central Auditory Processing

                                                                    Disorder ADHD and Executive Dysfunction

                                                                    The Executive Functions

                                                                    Internalizing speech Previewing

                                                                    Prioritizing Tempo control Inhibition

                                                                    The Executive Functions

                                                                    Determining salience (whatrsquos in it for me)

                                                                    Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                    Appropriate expectations

                                                                    Age-appropriate expectations

                                                                    Preschool 1-step errands Chores with cues Basic inhibition

                                                                    Age-appropriate expectations

                                                                    K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                    3rd ndash 5th

                                                                    Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                    Age-appropriate expectations

                                                                    6th ndash 8th

                                                                    complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                    Age-appropriate expectations

                                                                    Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                    already made Take othersrsquo perspective

                                                                    Age-appropriate expectations

                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                    Inter-connectedness of systems Cortico-striatal system for example

                                                                    Strategies

                                                                    Pharmacotherapy

                                                                    X

                                                                    Behavioral Supports

                                                                    A B C

                                                                    A B C

                                                                    behavior

                                                                    A B C

                                                                    consequences

                                                                    A B C

                                                                    antecedent

                                                                    A B C

                                                                    A B C

                                                                    antecedent

                                                                    A B C

                                                                    antecedent

                                                                    easy hard

                                                                    A B C

                                                                    consequences

                                                                    R P

                                                                    +

                                                                    -

                                                                    R+ P+

                                                                    R- P-

                                                                    Time Out

                                                                    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                    Token economy

                                                                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                    Intrinsic motivation

                                                                    A B C

                                                                    consequencesX

                                                                    A B C

                                                                    behavior

                                                                    Metacognition

                                                                    Metacognitive knowledge Metacognitive strategies

                                                                    ldquoLend Me Your Brainrdquo

                                                                    What Does Dopamine Feel Like

                                                                    The Physiology of Motivation and Reward

                                                                    Preferred States What Does Dopamine Feel Like

                                                                    1 Great experience2 Kodak moment3 The feeeeling

                                                                    David D Nowell PhD189 May Street

                                                                    Worcester Mass 01602DrNowellcom

                                                                    PREFERRED STATES INVENTORY

                                                                    wwwLulucom

                                                                    Identify 20 peak experiences For each peak experience identify the

                                                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                    of that moment Name it Check the 20 peak moment-feelings for

                                                                    clusters groupings There will probably be 4 or 5

                                                                    PREFERRED STATES INVENTORY

                                                                    Find a word a label for each of the groupings

                                                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                    ldquovaluesrdquo ways that you really like to feel

                                                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                    PREFERRED STATES INVENTORY

                                                                    PREFERRED STATES INVENTORY

                                                                    Broaden and Build

                                                                    ldquoNeuroMalleabilityrdquo

                                                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                    The reward-and-planning system

                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                    The reward-and-planning system

                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                    Lend Me Your Brain

                                                                    Supporting Clients with Executive Dysfunction

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                    Too busy with current activity

                                                                    Field dependent

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Sequence problem-solve

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Block out distractions

                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                    - E Goldberg

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Get the reward

                                                                    Ways the reward-and-planning system can go wrong

                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                    Instant gratification vs

                                                                    executive gratification

                                                                    A B C

                                                                    behaviorx

                                                                    Self-Talk Proficiency

                                                                    Self-Talk Proficiency

                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                    takerdquordquo

                                                                    Self-Talk Proficiency

                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                    Self-Talk Proficiency

                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                    thathelliprdquo

                                                                    Match the Picture

                                                                    Distraction Delay Training

                                                                    Executive Estimates Training

                                                                    X

                                                                    Learning Time

                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                    Learning Time

                                                                    Learning Time

                                                                    Learning Time

                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                    Asking two questionshellip

                                                                    Am I having fun now And is this what I set out to do

                                                                    Am I having fun nowIs

                                                                    this

                                                                    what

                                                                    I se

                                                                    t out

                                                                    to

                                                                    do

                                                                    bullYesbullYes

                                                                    bullNobullYes

                                                                    bullYesbullNo

                                                                    bullNobullNo

                                                                    Am I having fun nowIs

                                                                    this

                                                                    what

                                                                    I se

                                                                    t out

                                                                    to

                                                                    do

                                                                    bullFunbullOn-task

                                                                    bullNot funbullOn-task

                                                                    bullFunbullNot on-task

                                                                    bullNot funbullNot on-task

                                                                    Key Features of Video Games

                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                    inappropriate behavior ndash never reverse this

                                                                    Key Features of Video Games

                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                    Volkow et al 2004

                                                                    Increase salience

                                                                    Increase salience

                                                                    Quarterly QI review

                                                                    The post-mortem

                                                                    Your 1 Organizational Tool

                                                                    Your 1 Organizational Tool

                                                                    Yoga read

                                                                    Staff meeting

                                                                    Planningsession

                                                                    Phone calls

                                                                    billing

                                                                    Your 1 Organizational Tool

                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                    Your 1 Organizational Tool

                                                                    Learn French

                                                                    Stop smoking

                                                                    Be a better spouse

                                                                    The ldquoBig Fiverdquo

                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                    The ldquoBig Fiverdquo

                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                    The ldquoBig Fiverdquo

                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                    The ldquoBig Fiverdquo

                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                    The ldquoBig Fiverdquo

                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                    A CHALLENGEhellip

                                                                    wwwDrNowellcom

                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                    DavidNowellSeminars

                                                                    DavidNowell

                                                                    • Slide 1
                                                                    • hellipa challenge
                                                                    • Slide 3
                                                                    • Perspective of this workshophellip
                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                    • ldquoBottom - uprdquo dysfunction
                                                                    • Slide 7
                                                                    • Whatrsquos the kidrsquos deal
                                                                    • Overview
                                                                    • This Dense Pudding
                                                                    • Sensory Processing Disorder
                                                                    • Slide 12
                                                                    • Slide 13
                                                                    • Developmental considerations
                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                    • Slide 17
                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                    • Slide 19
                                                                    • Strategies
                                                                    • Regulatory-Sensory Processing Disorders
                                                                    • Slide 22
                                                                    • Slide 23
                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                    • Slide 25
                                                                    • Central Auditory Processing Disorder
                                                                    • Slide 27
                                                                    • Slide 28
                                                                    • Slide 29
                                                                    • Central Auditory Processing Disorder (2)
                                                                    • Central Auditory Processing Disorder (3)
                                                                    • Central Auditory Processing Disorder (4)
                                                                    • CAPD or ADHD
                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                    • Slide 35
                                                                    • Strategies (2)
                                                                    • (C)APD
                                                                    • Treatment for CAPD
                                                                    • Treatment for CAPD (2)
                                                                    • Self-assessment
                                                                    • Attention Deficit Hyperactivity Disorder
                                                                    • Slide 42
                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                    • (85 ndash X) x 365
                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                    • Core symptoms
                                                                    • Core symptoms (2)
                                                                    • hellipand the rest of the criteria
                                                                    • Slide 49
                                                                    • Functional impact of core symptoms
                                                                    • Functional impact of core symptoms (2)
                                                                    • Functional impact of core symptoms (3)
                                                                    • Slide 53
                                                                    • Functional impact of core symptoms (4)
                                                                    • Functional impact of core symptoms (5)
                                                                    • Functional impact of core symptoms (6)
                                                                    • Functional impact of core symptoms (7)
                                                                    • Functional impact of core symptoms (8)
                                                                    • Functional impact of core symptoms (9)
                                                                    • Subtypes of ADHD
                                                                    • Subtypes of ADHD (2)
                                                                    • Common comorbidities with ADHD
                                                                    • Slide 63
                                                                    • Common comorbidities with ADHD (2)
                                                                    • ADHD and girls
                                                                    • Slide 66
                                                                    • Slide 67
                                                                    • ADHD and women
                                                                    • Slide 69
                                                                    • ADHD and women (2)
                                                                    • Executive Functioning An Overarching Theme
                                                                    • The Executive Functions
                                                                    • The Executive Functions (2)
                                                                    • Slide 74
                                                                    • Slide 75
                                                                    • Appropriate expectations
                                                                    • Age-appropriate expectations
                                                                    • Age-appropriate expectations (2)
                                                                    • Age-appropriate expectations (3)
                                                                    • Age-appropriate expectations (4)
                                                                    • Age-appropriate expectations (5)
                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                    • Slide 84
                                                                    • Slide 85
                                                                    • Strategies (3)
                                                                    • Pharmacotherapy
                                                                    • Behavioral Supports
                                                                    • Slide 89
                                                                    • Slide 90
                                                                    • Slide 91
                                                                    • Slide 92
                                                                    • Slide 93
                                                                    • Slide 94
                                                                    • Slide 95
                                                                    • Slide 96
                                                                    • Slide 97
                                                                    • Slide 98
                                                                    • Slide 99
                                                                    • Slide 100
                                                                    • Slide 101
                                                                    • Slide 102
                                                                    • Slide 103
                                                                    • Slide 104
                                                                    • Slide 105
                                                                    • Slide 106
                                                                    • Slide 107
                                                                    • Slide 108
                                                                    • Slide 109
                                                                    • Slide 110
                                                                    • Time Out
                                                                    • Token economy
                                                                    • Slide 113
                                                                    • Slide 114
                                                                    • Slide 115
                                                                    • Intrinsic motivation
                                                                    • Slide 117
                                                                    • Slide 118
                                                                    • Slide 119
                                                                    • Metacognition
                                                                    • ldquoLend Me Your Brainrdquo
                                                                    • What Does Dopamine Feel Like
                                                                    • Preferred States What Does Dopamine Feel Like
                                                                    • Slide 124
                                                                    • PREFERRED STATES INVENTORY
                                                                    • PREFERRED STATES INVENTORY (2)
                                                                    • PREFERRED STATES INVENTORY (3)
                                                                    • Slide 128
                                                                    • Slide 129
                                                                    • Broaden and Build
                                                                    • ldquoNeuroMalleabilityrdquo
                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                    • The reward-and-planning system
                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                    • The reward-and-planning system (2)
                                                                    • Ways the reward-and-planning system can go wrong
                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                    • Slide 141
                                                                    • Lend Me Your Brain
                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                    • Slide 146
                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                    • Slide 149
                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                    • Slide 152
                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                    • Slide 154
                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                    • Slide 157
                                                                    • Slide 158
                                                                    • Slide 159
                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                    • Slide 162
                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                    • Slide 164
                                                                    • Instant gratification vs executive gratification
                                                                    • Slide 166
                                                                    • Slide 167
                                                                    • Slide 168
                                                                    • Slide 169
                                                                    • Slide 170
                                                                    • Self-Talk Proficiency
                                                                    • Self-Talk Proficiency (2)
                                                                    • Self-Talk Proficiency (3)
                                                                    • Self-Talk Proficiency (4)
                                                                    • Match the Picture
                                                                    • Slide 176
                                                                    • Slide 177
                                                                    • Distraction Delay Training
                                                                    • Slide 179
                                                                    • Slide 180
                                                                    • Executive Estimates Training
                                                                    • Learning Time
                                                                    • Learning Time (2)
                                                                    • Learning Time (3)
                                                                    • Slide 185
                                                                    • Slide 186
                                                                    • Learning Time (4)
                                                                    • Asking two questionshellip
                                                                    • Slide 189
                                                                    • Slide 190
                                                                    • Key Features of Video Games
                                                                    • Key Features of Video Games (2)
                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                    • Slide 194
                                                                    • Slide 195
                                                                    • Slide 196
                                                                    • Slide 197
                                                                    • Slide 198
                                                                    • Slide 199
                                                                    • Slide 200
                                                                    • Slide 201
                                                                    • Quarterly QI review
                                                                    • The post-mortem
                                                                    • Slide 204
                                                                    • Slide 205
                                                                    • Slide 206
                                                                    • Slide 207
                                                                    • Slide 208
                                                                    • Slide 209
                                                                    • Slide 210
                                                                    • The ldquoBig Fiverdquo
                                                                    • Slide 212
                                                                    • Slide 213
                                                                    • The ldquoBig Fiverdquo (2)
                                                                    • Slide 215
                                                                    • Slide 216
                                                                    • Slide 217
                                                                    • The ldquoBig Fiverdquo (3)
                                                                    • The ldquoBig Fiverdquo (4)
                                                                    • The ldquoBig Fiverdquo (5)
                                                                    • A challengehellip
                                                                    • Slide 222

                                                                      Core symptoms

                                                                      Inattention distractibility

                                                                      Core symptoms

                                                                      Hyperactivity impulsivity

                                                                      hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                                      mental disorder

                                                                      Functional impact of core symptoms

                                                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                      Functional impact of core symptoms

                                                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                      Functional impact of core symptoms

                                                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                      Functional impact of core symptoms

                                                                      Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                      Functional impact of core symptoms

                                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                      Functional impact of core symptoms

                                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                      Functional impact of core symptoms

                                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                      Functional impact of core symptoms

                                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                      Functional impact of core symptoms

                                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                      Subtypes of ADHD

                                                                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                      Subtypes of ADHD

                                                                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                      Specifed

                                                                      Common comorbidities with ADHD

                                                                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                      processing challenges

                                                                      Common comorbidities with ADHD

                                                                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                      processing challenges

                                                                      ADHD and girls

                                                                      ADHD and women

                                                                      ADHD and women

                                                                      More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                      partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                      disorganization

                                                                      Executive FunctioningAn Overarching Theme

                                                                      Sensory Processing Disorder Central Auditory Processing

                                                                      Disorder ADHD and Executive Dysfunction

                                                                      The Executive Functions

                                                                      Internalizing speech Previewing

                                                                      Prioritizing Tempo control Inhibition

                                                                      The Executive Functions

                                                                      Determining salience (whatrsquos in it for me)

                                                                      Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                      Appropriate expectations

                                                                      Age-appropriate expectations

                                                                      Preschool 1-step errands Chores with cues Basic inhibition

                                                                      Age-appropriate expectations

                                                                      K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                      3rd ndash 5th

                                                                      Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                      Age-appropriate expectations

                                                                      6th ndash 8th

                                                                      complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                      Age-appropriate expectations

                                                                      Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                      already made Take othersrsquo perspective

                                                                      Age-appropriate expectations

                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                      Inter-connectedness of systems Cortico-striatal system for example

                                                                      Strategies

                                                                      Pharmacotherapy

                                                                      X

                                                                      Behavioral Supports

                                                                      A B C

                                                                      A B C

                                                                      behavior

                                                                      A B C

                                                                      consequences

                                                                      A B C

                                                                      antecedent

                                                                      A B C

                                                                      A B C

                                                                      antecedent

                                                                      A B C

                                                                      antecedent

                                                                      easy hard

                                                                      A B C

                                                                      consequences

                                                                      R P

                                                                      +

                                                                      -

                                                                      R+ P+

                                                                      R- P-

                                                                      Time Out

                                                                      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                      Token economy

                                                                      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                      Intrinsic motivation

                                                                      A B C

                                                                      consequencesX

                                                                      A B C

                                                                      behavior

                                                                      Metacognition

                                                                      Metacognitive knowledge Metacognitive strategies

                                                                      ldquoLend Me Your Brainrdquo

                                                                      What Does Dopamine Feel Like

                                                                      The Physiology of Motivation and Reward

                                                                      Preferred States What Does Dopamine Feel Like

                                                                      1 Great experience2 Kodak moment3 The feeeeling

                                                                      David D Nowell PhD189 May Street

                                                                      Worcester Mass 01602DrNowellcom

                                                                      PREFERRED STATES INVENTORY

                                                                      wwwLulucom

                                                                      Identify 20 peak experiences For each peak experience identify the

                                                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                      of that moment Name it Check the 20 peak moment-feelings for

                                                                      clusters groupings There will probably be 4 or 5

                                                                      PREFERRED STATES INVENTORY

                                                                      Find a word a label for each of the groupings

                                                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                      ldquovaluesrdquo ways that you really like to feel

                                                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                      PREFERRED STATES INVENTORY

                                                                      PREFERRED STATES INVENTORY

                                                                      Broaden and Build

                                                                      ldquoNeuroMalleabilityrdquo

                                                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                      The reward-and-planning system

                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                      The reward-and-planning system

                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                      Lend Me Your Brain

                                                                      Supporting Clients with Executive Dysfunction

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                      Too busy with current activity

                                                                      Field dependent

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Sequence problem-solve

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Block out distractions

                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                      - E Goldberg

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Get the reward

                                                                      Ways the reward-and-planning system can go wrong

                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                      Instant gratification vs

                                                                      executive gratification

                                                                      A B C

                                                                      behaviorx

                                                                      Self-Talk Proficiency

                                                                      Self-Talk Proficiency

                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                      takerdquordquo

                                                                      Self-Talk Proficiency

                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                      Self-Talk Proficiency

                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                      thathelliprdquo

                                                                      Match the Picture

                                                                      Distraction Delay Training

                                                                      Executive Estimates Training

                                                                      X

                                                                      Learning Time

                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                      Learning Time

                                                                      Learning Time

                                                                      Learning Time

                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                      Asking two questionshellip

                                                                      Am I having fun now And is this what I set out to do

                                                                      Am I having fun nowIs

                                                                      this

                                                                      what

                                                                      I se

                                                                      t out

                                                                      to

                                                                      do

                                                                      bullYesbullYes

                                                                      bullNobullYes

                                                                      bullYesbullNo

                                                                      bullNobullNo

                                                                      Am I having fun nowIs

                                                                      this

                                                                      what

                                                                      I se

                                                                      t out

                                                                      to

                                                                      do

                                                                      bullFunbullOn-task

                                                                      bullNot funbullOn-task

                                                                      bullFunbullNot on-task

                                                                      bullNot funbullNot on-task

                                                                      Key Features of Video Games

                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                      inappropriate behavior ndash never reverse this

                                                                      Key Features of Video Games

                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                      Volkow et al 2004

                                                                      Increase salience

                                                                      Increase salience

                                                                      Quarterly QI review

                                                                      The post-mortem

                                                                      Your 1 Organizational Tool

                                                                      Your 1 Organizational Tool

                                                                      Yoga read

                                                                      Staff meeting

                                                                      Planningsession

                                                                      Phone calls

                                                                      billing

                                                                      Your 1 Organizational Tool

                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                      Your 1 Organizational Tool

                                                                      Learn French

                                                                      Stop smoking

                                                                      Be a better spouse

                                                                      The ldquoBig Fiverdquo

                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                      The ldquoBig Fiverdquo

                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                      The ldquoBig Fiverdquo

                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                      The ldquoBig Fiverdquo

                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                      The ldquoBig Fiverdquo

                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                      A CHALLENGEhellip

                                                                      wwwDrNowellcom

                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                      DavidNowellSeminars

                                                                      DavidNowell

                                                                      • Slide 1
                                                                      • hellipa challenge
                                                                      • Slide 3
                                                                      • Perspective of this workshophellip
                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                      • ldquoBottom - uprdquo dysfunction
                                                                      • Slide 7
                                                                      • Whatrsquos the kidrsquos deal
                                                                      • Overview
                                                                      • This Dense Pudding
                                                                      • Sensory Processing Disorder
                                                                      • Slide 12
                                                                      • Slide 13
                                                                      • Developmental considerations
                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                      • Slide 17
                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                      • Slide 19
                                                                      • Strategies
                                                                      • Regulatory-Sensory Processing Disorders
                                                                      • Slide 22
                                                                      • Slide 23
                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                      • Slide 25
                                                                      • Central Auditory Processing Disorder
                                                                      • Slide 27
                                                                      • Slide 28
                                                                      • Slide 29
                                                                      • Central Auditory Processing Disorder (2)
                                                                      • Central Auditory Processing Disorder (3)
                                                                      • Central Auditory Processing Disorder (4)
                                                                      • CAPD or ADHD
                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                      • Slide 35
                                                                      • Strategies (2)
                                                                      • (C)APD
                                                                      • Treatment for CAPD
                                                                      • Treatment for CAPD (2)
                                                                      • Self-assessment
                                                                      • Attention Deficit Hyperactivity Disorder
                                                                      • Slide 42
                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                      • (85 ndash X) x 365
                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                      • Core symptoms
                                                                      • Core symptoms (2)
                                                                      • hellipand the rest of the criteria
                                                                      • Slide 49
                                                                      • Functional impact of core symptoms
                                                                      • Functional impact of core symptoms (2)
                                                                      • Functional impact of core symptoms (3)
                                                                      • Slide 53
                                                                      • Functional impact of core symptoms (4)
                                                                      • Functional impact of core symptoms (5)
                                                                      • Functional impact of core symptoms (6)
                                                                      • Functional impact of core symptoms (7)
                                                                      • Functional impact of core symptoms (8)
                                                                      • Functional impact of core symptoms (9)
                                                                      • Subtypes of ADHD
                                                                      • Subtypes of ADHD (2)
                                                                      • Common comorbidities with ADHD
                                                                      • Slide 63
                                                                      • Common comorbidities with ADHD (2)
                                                                      • ADHD and girls
                                                                      • Slide 66
                                                                      • Slide 67
                                                                      • ADHD and women
                                                                      • Slide 69
                                                                      • ADHD and women (2)
                                                                      • Executive Functioning An Overarching Theme
                                                                      • The Executive Functions
                                                                      • The Executive Functions (2)
                                                                      • Slide 74
                                                                      • Slide 75
                                                                      • Appropriate expectations
                                                                      • Age-appropriate expectations
                                                                      • Age-appropriate expectations (2)
                                                                      • Age-appropriate expectations (3)
                                                                      • Age-appropriate expectations (4)
                                                                      • Age-appropriate expectations (5)
                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                      • Slide 84
                                                                      • Slide 85
                                                                      • Strategies (3)
                                                                      • Pharmacotherapy
                                                                      • Behavioral Supports
                                                                      • Slide 89
                                                                      • Slide 90
                                                                      • Slide 91
                                                                      • Slide 92
                                                                      • Slide 93
                                                                      • Slide 94
                                                                      • Slide 95
                                                                      • Slide 96
                                                                      • Slide 97
                                                                      • Slide 98
                                                                      • Slide 99
                                                                      • Slide 100
                                                                      • Slide 101
                                                                      • Slide 102
                                                                      • Slide 103
                                                                      • Slide 104
                                                                      • Slide 105
                                                                      • Slide 106
                                                                      • Slide 107
                                                                      • Slide 108
                                                                      • Slide 109
                                                                      • Slide 110
                                                                      • Time Out
                                                                      • Token economy
                                                                      • Slide 113
                                                                      • Slide 114
                                                                      • Slide 115
                                                                      • Intrinsic motivation
                                                                      • Slide 117
                                                                      • Slide 118
                                                                      • Slide 119
                                                                      • Metacognition
                                                                      • ldquoLend Me Your Brainrdquo
                                                                      • What Does Dopamine Feel Like
                                                                      • Preferred States What Does Dopamine Feel Like
                                                                      • Slide 124
                                                                      • PREFERRED STATES INVENTORY
                                                                      • PREFERRED STATES INVENTORY (2)
                                                                      • PREFERRED STATES INVENTORY (3)
                                                                      • Slide 128
                                                                      • Slide 129
                                                                      • Broaden and Build
                                                                      • ldquoNeuroMalleabilityrdquo
                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                      • The reward-and-planning system
                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                      • The reward-and-planning system (2)
                                                                      • Ways the reward-and-planning system can go wrong
                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                      • Slide 141
                                                                      • Lend Me Your Brain
                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                      • Slide 146
                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                      • Slide 149
                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                      • Slide 152
                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                      • Slide 154
                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                      • Slide 157
                                                                      • Slide 158
                                                                      • Slide 159
                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                      • Slide 162
                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                      • Slide 164
                                                                      • Instant gratification vs executive gratification
                                                                      • Slide 166
                                                                      • Slide 167
                                                                      • Slide 168
                                                                      • Slide 169
                                                                      • Slide 170
                                                                      • Self-Talk Proficiency
                                                                      • Self-Talk Proficiency (2)
                                                                      • Self-Talk Proficiency (3)
                                                                      • Self-Talk Proficiency (4)
                                                                      • Match the Picture
                                                                      • Slide 176
                                                                      • Slide 177
                                                                      • Distraction Delay Training
                                                                      • Slide 179
                                                                      • Slide 180
                                                                      • Executive Estimates Training
                                                                      • Learning Time
                                                                      • Learning Time (2)
                                                                      • Learning Time (3)
                                                                      • Slide 185
                                                                      • Slide 186
                                                                      • Learning Time (4)
                                                                      • Asking two questionshellip
                                                                      • Slide 189
                                                                      • Slide 190
                                                                      • Key Features of Video Games
                                                                      • Key Features of Video Games (2)
                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                      • Slide 194
                                                                      • Slide 195
                                                                      • Slide 196
                                                                      • Slide 197
                                                                      • Slide 198
                                                                      • Slide 199
                                                                      • Slide 200
                                                                      • Slide 201
                                                                      • Quarterly QI review
                                                                      • The post-mortem
                                                                      • Slide 204
                                                                      • Slide 205
                                                                      • Slide 206
                                                                      • Slide 207
                                                                      • Slide 208
                                                                      • Slide 209
                                                                      • Slide 210
                                                                      • The ldquoBig Fiverdquo
                                                                      • Slide 212
                                                                      • Slide 213
                                                                      • The ldquoBig Fiverdquo (2)
                                                                      • Slide 215
                                                                      • Slide 216
                                                                      • Slide 217
                                                                      • The ldquoBig Fiverdquo (3)
                                                                      • The ldquoBig Fiverdquo (4)
                                                                      • The ldquoBig Fiverdquo (5)
                                                                      • A challengehellip
                                                                      • Slide 222

                                                                        Core symptoms

                                                                        Hyperactivity impulsivity

                                                                        hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                                        mental disorder

                                                                        Functional impact of core symptoms

                                                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                        Functional impact of core symptoms

                                                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                        Functional impact of core symptoms

                                                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                        Functional impact of core symptoms

                                                                        Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                        Functional impact of core symptoms

                                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                        Functional impact of core symptoms

                                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                        Functional impact of core symptoms

                                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                        Functional impact of core symptoms

                                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                        Functional impact of core symptoms

                                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                        Subtypes of ADHD

                                                                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                        Subtypes of ADHD

                                                                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                        Specifed

                                                                        Common comorbidities with ADHD

                                                                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                        processing challenges

                                                                        Common comorbidities with ADHD

                                                                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                        processing challenges

                                                                        ADHD and girls

                                                                        ADHD and women

                                                                        ADHD and women

                                                                        More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                        partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                        disorganization

                                                                        Executive FunctioningAn Overarching Theme

                                                                        Sensory Processing Disorder Central Auditory Processing

                                                                        Disorder ADHD and Executive Dysfunction

                                                                        The Executive Functions

                                                                        Internalizing speech Previewing

                                                                        Prioritizing Tempo control Inhibition

                                                                        The Executive Functions

                                                                        Determining salience (whatrsquos in it for me)

                                                                        Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                        Appropriate expectations

                                                                        Age-appropriate expectations

                                                                        Preschool 1-step errands Chores with cues Basic inhibition

                                                                        Age-appropriate expectations

                                                                        K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                        3rd ndash 5th

                                                                        Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                        Age-appropriate expectations

                                                                        6th ndash 8th

                                                                        complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                        Age-appropriate expectations

                                                                        Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                        already made Take othersrsquo perspective

                                                                        Age-appropriate expectations

                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                        Inter-connectedness of systems Cortico-striatal system for example

                                                                        Strategies

                                                                        Pharmacotherapy

                                                                        X

                                                                        Behavioral Supports

                                                                        A B C

                                                                        A B C

                                                                        behavior

                                                                        A B C

                                                                        consequences

                                                                        A B C

                                                                        antecedent

                                                                        A B C

                                                                        A B C

                                                                        antecedent

                                                                        A B C

                                                                        antecedent

                                                                        easy hard

                                                                        A B C

                                                                        consequences

                                                                        R P

                                                                        +

                                                                        -

                                                                        R+ P+

                                                                        R- P-

                                                                        Time Out

                                                                        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                        Token economy

                                                                        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                        Intrinsic motivation

                                                                        A B C

                                                                        consequencesX

                                                                        A B C

                                                                        behavior

                                                                        Metacognition

                                                                        Metacognitive knowledge Metacognitive strategies

                                                                        ldquoLend Me Your Brainrdquo

                                                                        What Does Dopamine Feel Like

                                                                        The Physiology of Motivation and Reward

                                                                        Preferred States What Does Dopamine Feel Like

                                                                        1 Great experience2 Kodak moment3 The feeeeling

                                                                        David D Nowell PhD189 May Street

                                                                        Worcester Mass 01602DrNowellcom

                                                                        PREFERRED STATES INVENTORY

                                                                        wwwLulucom

                                                                        Identify 20 peak experiences For each peak experience identify the

                                                                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                        of that moment Name it Check the 20 peak moment-feelings for

                                                                        clusters groupings There will probably be 4 or 5

                                                                        PREFERRED STATES INVENTORY

                                                                        Find a word a label for each of the groupings

                                                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                        ldquovaluesrdquo ways that you really like to feel

                                                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                        PREFERRED STATES INVENTORY

                                                                        PREFERRED STATES INVENTORY

                                                                        Broaden and Build

                                                                        ldquoNeuroMalleabilityrdquo

                                                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                        The reward-and-planning system

                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                        The reward-and-planning system

                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                        Lend Me Your Brain

                                                                        Supporting Clients with Executive Dysfunction

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                        Too busy with current activity

                                                                        Field dependent

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Sequence problem-solve

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Block out distractions

                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                        - E Goldberg

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Get the reward

                                                                        Ways the reward-and-planning system can go wrong

                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                        Instant gratification vs

                                                                        executive gratification

                                                                        A B C

                                                                        behaviorx

                                                                        Self-Talk Proficiency

                                                                        Self-Talk Proficiency

                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                        takerdquordquo

                                                                        Self-Talk Proficiency

                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                        Self-Talk Proficiency

                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                        thathelliprdquo

                                                                        Match the Picture

                                                                        Distraction Delay Training

                                                                        Executive Estimates Training

                                                                        X

                                                                        Learning Time

                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                        Learning Time

                                                                        Learning Time

                                                                        Learning Time

                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                        Asking two questionshellip

                                                                        Am I having fun now And is this what I set out to do

                                                                        Am I having fun nowIs

                                                                        this

                                                                        what

                                                                        I se

                                                                        t out

                                                                        to

                                                                        do

                                                                        bullYesbullYes

                                                                        bullNobullYes

                                                                        bullYesbullNo

                                                                        bullNobullNo

                                                                        Am I having fun nowIs

                                                                        this

                                                                        what

                                                                        I se

                                                                        t out

                                                                        to

                                                                        do

                                                                        bullFunbullOn-task

                                                                        bullNot funbullOn-task

                                                                        bullFunbullNot on-task

                                                                        bullNot funbullNot on-task

                                                                        Key Features of Video Games

                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                        inappropriate behavior ndash never reverse this

                                                                        Key Features of Video Games

                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                        Volkow et al 2004

                                                                        Increase salience

                                                                        Increase salience

                                                                        Quarterly QI review

                                                                        The post-mortem

                                                                        Your 1 Organizational Tool

                                                                        Your 1 Organizational Tool

                                                                        Yoga read

                                                                        Staff meeting

                                                                        Planningsession

                                                                        Phone calls

                                                                        billing

                                                                        Your 1 Organizational Tool

                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                        Your 1 Organizational Tool

                                                                        Learn French

                                                                        Stop smoking

                                                                        Be a better spouse

                                                                        The ldquoBig Fiverdquo

                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                        The ldquoBig Fiverdquo

                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                        The ldquoBig Fiverdquo

                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                        The ldquoBig Fiverdquo

                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                        The ldquoBig Fiverdquo

                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                        A CHALLENGEhellip

                                                                        wwwDrNowellcom

                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                        DavidNowellSeminars

                                                                        DavidNowell

                                                                        • Slide 1
                                                                        • hellipa challenge
                                                                        • Slide 3
                                                                        • Perspective of this workshophellip
                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                        • ldquoBottom - uprdquo dysfunction
                                                                        • Slide 7
                                                                        • Whatrsquos the kidrsquos deal
                                                                        • Overview
                                                                        • This Dense Pudding
                                                                        • Sensory Processing Disorder
                                                                        • Slide 12
                                                                        • Slide 13
                                                                        • Developmental considerations
                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                        • Slide 17
                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                        • Slide 19
                                                                        • Strategies
                                                                        • Regulatory-Sensory Processing Disorders
                                                                        • Slide 22
                                                                        • Slide 23
                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                        • Slide 25
                                                                        • Central Auditory Processing Disorder
                                                                        • Slide 27
                                                                        • Slide 28
                                                                        • Slide 29
                                                                        • Central Auditory Processing Disorder (2)
                                                                        • Central Auditory Processing Disorder (3)
                                                                        • Central Auditory Processing Disorder (4)
                                                                        • CAPD or ADHD
                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                        • Slide 35
                                                                        • Strategies (2)
                                                                        • (C)APD
                                                                        • Treatment for CAPD
                                                                        • Treatment for CAPD (2)
                                                                        • Self-assessment
                                                                        • Attention Deficit Hyperactivity Disorder
                                                                        • Slide 42
                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                        • (85 ndash X) x 365
                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                        • Core symptoms
                                                                        • Core symptoms (2)
                                                                        • hellipand the rest of the criteria
                                                                        • Slide 49
                                                                        • Functional impact of core symptoms
                                                                        • Functional impact of core symptoms (2)
                                                                        • Functional impact of core symptoms (3)
                                                                        • Slide 53
                                                                        • Functional impact of core symptoms (4)
                                                                        • Functional impact of core symptoms (5)
                                                                        • Functional impact of core symptoms (6)
                                                                        • Functional impact of core symptoms (7)
                                                                        • Functional impact of core symptoms (8)
                                                                        • Functional impact of core symptoms (9)
                                                                        • Subtypes of ADHD
                                                                        • Subtypes of ADHD (2)
                                                                        • Common comorbidities with ADHD
                                                                        • Slide 63
                                                                        • Common comorbidities with ADHD (2)
                                                                        • ADHD and girls
                                                                        • Slide 66
                                                                        • Slide 67
                                                                        • ADHD and women
                                                                        • Slide 69
                                                                        • ADHD and women (2)
                                                                        • Executive Functioning An Overarching Theme
                                                                        • The Executive Functions
                                                                        • The Executive Functions (2)
                                                                        • Slide 74
                                                                        • Slide 75
                                                                        • Appropriate expectations
                                                                        • Age-appropriate expectations
                                                                        • Age-appropriate expectations (2)
                                                                        • Age-appropriate expectations (3)
                                                                        • Age-appropriate expectations (4)
                                                                        • Age-appropriate expectations (5)
                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                        • Slide 84
                                                                        • Slide 85
                                                                        • Strategies (3)
                                                                        • Pharmacotherapy
                                                                        • Behavioral Supports
                                                                        • Slide 89
                                                                        • Slide 90
                                                                        • Slide 91
                                                                        • Slide 92
                                                                        • Slide 93
                                                                        • Slide 94
                                                                        • Slide 95
                                                                        • Slide 96
                                                                        • Slide 97
                                                                        • Slide 98
                                                                        • Slide 99
                                                                        • Slide 100
                                                                        • Slide 101
                                                                        • Slide 102
                                                                        • Slide 103
                                                                        • Slide 104
                                                                        • Slide 105
                                                                        • Slide 106
                                                                        • Slide 107
                                                                        • Slide 108
                                                                        • Slide 109
                                                                        • Slide 110
                                                                        • Time Out
                                                                        • Token economy
                                                                        • Slide 113
                                                                        • Slide 114
                                                                        • Slide 115
                                                                        • Intrinsic motivation
                                                                        • Slide 117
                                                                        • Slide 118
                                                                        • Slide 119
                                                                        • Metacognition
                                                                        • ldquoLend Me Your Brainrdquo
                                                                        • What Does Dopamine Feel Like
                                                                        • Preferred States What Does Dopamine Feel Like
                                                                        • Slide 124
                                                                        • PREFERRED STATES INVENTORY
                                                                        • PREFERRED STATES INVENTORY (2)
                                                                        • PREFERRED STATES INVENTORY (3)
                                                                        • Slide 128
                                                                        • Slide 129
                                                                        • Broaden and Build
                                                                        • ldquoNeuroMalleabilityrdquo
                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                        • The reward-and-planning system
                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                        • The reward-and-planning system (2)
                                                                        • Ways the reward-and-planning system can go wrong
                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                        • Slide 141
                                                                        • Lend Me Your Brain
                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                        • Slide 146
                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                        • Slide 149
                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                        • Slide 152
                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                        • Slide 154
                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                        • Slide 157
                                                                        • Slide 158
                                                                        • Slide 159
                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                        • Slide 162
                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                        • Slide 164
                                                                        • Instant gratification vs executive gratification
                                                                        • Slide 166
                                                                        • Slide 167
                                                                        • Slide 168
                                                                        • Slide 169
                                                                        • Slide 170
                                                                        • Self-Talk Proficiency
                                                                        • Self-Talk Proficiency (2)
                                                                        • Self-Talk Proficiency (3)
                                                                        • Self-Talk Proficiency (4)
                                                                        • Match the Picture
                                                                        • Slide 176
                                                                        • Slide 177
                                                                        • Distraction Delay Training
                                                                        • Slide 179
                                                                        • Slide 180
                                                                        • Executive Estimates Training
                                                                        • Learning Time
                                                                        • Learning Time (2)
                                                                        • Learning Time (3)
                                                                        • Slide 185
                                                                        • Slide 186
                                                                        • Learning Time (4)
                                                                        • Asking two questionshellip
                                                                        • Slide 189
                                                                        • Slide 190
                                                                        • Key Features of Video Games
                                                                        • Key Features of Video Games (2)
                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                        • Slide 194
                                                                        • Slide 195
                                                                        • Slide 196
                                                                        • Slide 197
                                                                        • Slide 198
                                                                        • Slide 199
                                                                        • Slide 200
                                                                        • Slide 201
                                                                        • Quarterly QI review
                                                                        • The post-mortem
                                                                        • Slide 204
                                                                        • Slide 205
                                                                        • Slide 206
                                                                        • Slide 207
                                                                        • Slide 208
                                                                        • Slide 209
                                                                        • Slide 210
                                                                        • The ldquoBig Fiverdquo
                                                                        • Slide 212
                                                                        • Slide 213
                                                                        • The ldquoBig Fiverdquo (2)
                                                                        • Slide 215
                                                                        • Slide 216
                                                                        • Slide 217
                                                                        • The ldquoBig Fiverdquo (3)
                                                                        • The ldquoBig Fiverdquo (4)
                                                                        • The ldquoBig Fiverdquo (5)
                                                                        • A challengehellip
                                                                        • Slide 222

                                                                          hellipand the rest of the criteriaB Onset before age 7C Impairment in 2 or more settingsD Significant functional impairmentE Not better accounted for by another

                                                                          mental disorder

                                                                          Functional impact of core symptoms

                                                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                          Functional impact of core symptoms

                                                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                          Functional impact of core symptoms

                                                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                          Functional impact of core symptoms

                                                                          Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                          Functional impact of core symptoms

                                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                          Functional impact of core symptoms

                                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                          Functional impact of core symptoms

                                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                          Functional impact of core symptoms

                                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                          Functional impact of core symptoms

                                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                          Subtypes of ADHD

                                                                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                          Subtypes of ADHD

                                                                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                          Specifed

                                                                          Common comorbidities with ADHD

                                                                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                          processing challenges

                                                                          Common comorbidities with ADHD

                                                                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                          processing challenges

                                                                          ADHD and girls

                                                                          ADHD and women

                                                                          ADHD and women

                                                                          More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                          partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                          disorganization

                                                                          Executive FunctioningAn Overarching Theme

                                                                          Sensory Processing Disorder Central Auditory Processing

                                                                          Disorder ADHD and Executive Dysfunction

                                                                          The Executive Functions

                                                                          Internalizing speech Previewing

                                                                          Prioritizing Tempo control Inhibition

                                                                          The Executive Functions

                                                                          Determining salience (whatrsquos in it for me)

                                                                          Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                          Appropriate expectations

                                                                          Age-appropriate expectations

                                                                          Preschool 1-step errands Chores with cues Basic inhibition

                                                                          Age-appropriate expectations

                                                                          K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                          3rd ndash 5th

                                                                          Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                          Age-appropriate expectations

                                                                          6th ndash 8th

                                                                          complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                          Age-appropriate expectations

                                                                          Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                          already made Take othersrsquo perspective

                                                                          Age-appropriate expectations

                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                          Inter-connectedness of systems Cortico-striatal system for example

                                                                          Strategies

                                                                          Pharmacotherapy

                                                                          X

                                                                          Behavioral Supports

                                                                          A B C

                                                                          A B C

                                                                          behavior

                                                                          A B C

                                                                          consequences

                                                                          A B C

                                                                          antecedent

                                                                          A B C

                                                                          A B C

                                                                          antecedent

                                                                          A B C

                                                                          antecedent

                                                                          easy hard

                                                                          A B C

                                                                          consequences

                                                                          R P

                                                                          +

                                                                          -

                                                                          R+ P+

                                                                          R- P-

                                                                          Time Out

                                                                          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                          Token economy

                                                                          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                          Intrinsic motivation

                                                                          A B C

                                                                          consequencesX

                                                                          A B C

                                                                          behavior

                                                                          Metacognition

                                                                          Metacognitive knowledge Metacognitive strategies

                                                                          ldquoLend Me Your Brainrdquo

                                                                          What Does Dopamine Feel Like

                                                                          The Physiology of Motivation and Reward

                                                                          Preferred States What Does Dopamine Feel Like

                                                                          1 Great experience2 Kodak moment3 The feeeeling

                                                                          David D Nowell PhD189 May Street

                                                                          Worcester Mass 01602DrNowellcom

                                                                          PREFERRED STATES INVENTORY

                                                                          wwwLulucom

                                                                          Identify 20 peak experiences For each peak experience identify the

                                                                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                          of that moment Name it Check the 20 peak moment-feelings for

                                                                          clusters groupings There will probably be 4 or 5

                                                                          PREFERRED STATES INVENTORY

                                                                          Find a word a label for each of the groupings

                                                                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                          ldquovaluesrdquo ways that you really like to feel

                                                                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                          PREFERRED STATES INVENTORY

                                                                          PREFERRED STATES INVENTORY

                                                                          Broaden and Build

                                                                          ldquoNeuroMalleabilityrdquo

                                                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                          The reward-and-planning system

                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                          The reward-and-planning system

                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                          Lend Me Your Brain

                                                                          Supporting Clients with Executive Dysfunction

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                          Too busy with current activity

                                                                          Field dependent

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Sequence problem-solve

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Block out distractions

                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                          - E Goldberg

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Get the reward

                                                                          Ways the reward-and-planning system can go wrong

                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                          Instant gratification vs

                                                                          executive gratification

                                                                          A B C

                                                                          behaviorx

                                                                          Self-Talk Proficiency

                                                                          Self-Talk Proficiency

                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                          takerdquordquo

                                                                          Self-Talk Proficiency

                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                          Self-Talk Proficiency

                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                          thathelliprdquo

                                                                          Match the Picture

                                                                          Distraction Delay Training

                                                                          Executive Estimates Training

                                                                          X

                                                                          Learning Time

                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                          Learning Time

                                                                          Learning Time

                                                                          Learning Time

                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                          Asking two questionshellip

                                                                          Am I having fun now And is this what I set out to do

                                                                          Am I having fun nowIs

                                                                          this

                                                                          what

                                                                          I se

                                                                          t out

                                                                          to

                                                                          do

                                                                          bullYesbullYes

                                                                          bullNobullYes

                                                                          bullYesbullNo

                                                                          bullNobullNo

                                                                          Am I having fun nowIs

                                                                          this

                                                                          what

                                                                          I se

                                                                          t out

                                                                          to

                                                                          do

                                                                          bullFunbullOn-task

                                                                          bullNot funbullOn-task

                                                                          bullFunbullNot on-task

                                                                          bullNot funbullNot on-task

                                                                          Key Features of Video Games

                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                          inappropriate behavior ndash never reverse this

                                                                          Key Features of Video Games

                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                          Volkow et al 2004

                                                                          Increase salience

                                                                          Increase salience

                                                                          Quarterly QI review

                                                                          The post-mortem

                                                                          Your 1 Organizational Tool

                                                                          Your 1 Organizational Tool

                                                                          Yoga read

                                                                          Staff meeting

                                                                          Planningsession

                                                                          Phone calls

                                                                          billing

                                                                          Your 1 Organizational Tool

                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                          Your 1 Organizational Tool

                                                                          Learn French

                                                                          Stop smoking

                                                                          Be a better spouse

                                                                          The ldquoBig Fiverdquo

                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                          The ldquoBig Fiverdquo

                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                          The ldquoBig Fiverdquo

                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                          The ldquoBig Fiverdquo

                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                          The ldquoBig Fiverdquo

                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                          A CHALLENGEhellip

                                                                          wwwDrNowellcom

                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                          DavidNowellSeminars

                                                                          DavidNowell

                                                                          • Slide 1
                                                                          • hellipa challenge
                                                                          • Slide 3
                                                                          • Perspective of this workshophellip
                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                          • ldquoBottom - uprdquo dysfunction
                                                                          • Slide 7
                                                                          • Whatrsquos the kidrsquos deal
                                                                          • Overview
                                                                          • This Dense Pudding
                                                                          • Sensory Processing Disorder
                                                                          • Slide 12
                                                                          • Slide 13
                                                                          • Developmental considerations
                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                          • Slide 17
                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                          • Slide 19
                                                                          • Strategies
                                                                          • Regulatory-Sensory Processing Disorders
                                                                          • Slide 22
                                                                          • Slide 23
                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                          • Slide 25
                                                                          • Central Auditory Processing Disorder
                                                                          • Slide 27
                                                                          • Slide 28
                                                                          • Slide 29
                                                                          • Central Auditory Processing Disorder (2)
                                                                          • Central Auditory Processing Disorder (3)
                                                                          • Central Auditory Processing Disorder (4)
                                                                          • CAPD or ADHD
                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                          • Slide 35
                                                                          • Strategies (2)
                                                                          • (C)APD
                                                                          • Treatment for CAPD
                                                                          • Treatment for CAPD (2)
                                                                          • Self-assessment
                                                                          • Attention Deficit Hyperactivity Disorder
                                                                          • Slide 42
                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                          • (85 ndash X) x 365
                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                          • Core symptoms
                                                                          • Core symptoms (2)
                                                                          • hellipand the rest of the criteria
                                                                          • Slide 49
                                                                          • Functional impact of core symptoms
                                                                          • Functional impact of core symptoms (2)
                                                                          • Functional impact of core symptoms (3)
                                                                          • Slide 53
                                                                          • Functional impact of core symptoms (4)
                                                                          • Functional impact of core symptoms (5)
                                                                          • Functional impact of core symptoms (6)
                                                                          • Functional impact of core symptoms (7)
                                                                          • Functional impact of core symptoms (8)
                                                                          • Functional impact of core symptoms (9)
                                                                          • Subtypes of ADHD
                                                                          • Subtypes of ADHD (2)
                                                                          • Common comorbidities with ADHD
                                                                          • Slide 63
                                                                          • Common comorbidities with ADHD (2)
                                                                          • ADHD and girls
                                                                          • Slide 66
                                                                          • Slide 67
                                                                          • ADHD and women
                                                                          • Slide 69
                                                                          • ADHD and women (2)
                                                                          • Executive Functioning An Overarching Theme
                                                                          • The Executive Functions
                                                                          • The Executive Functions (2)
                                                                          • Slide 74
                                                                          • Slide 75
                                                                          • Appropriate expectations
                                                                          • Age-appropriate expectations
                                                                          • Age-appropriate expectations (2)
                                                                          • Age-appropriate expectations (3)
                                                                          • Age-appropriate expectations (4)
                                                                          • Age-appropriate expectations (5)
                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                          • Slide 84
                                                                          • Slide 85
                                                                          • Strategies (3)
                                                                          • Pharmacotherapy
                                                                          • Behavioral Supports
                                                                          • Slide 89
                                                                          • Slide 90
                                                                          • Slide 91
                                                                          • Slide 92
                                                                          • Slide 93
                                                                          • Slide 94
                                                                          • Slide 95
                                                                          • Slide 96
                                                                          • Slide 97
                                                                          • Slide 98
                                                                          • Slide 99
                                                                          • Slide 100
                                                                          • Slide 101
                                                                          • Slide 102
                                                                          • Slide 103
                                                                          • Slide 104
                                                                          • Slide 105
                                                                          • Slide 106
                                                                          • Slide 107
                                                                          • Slide 108
                                                                          • Slide 109
                                                                          • Slide 110
                                                                          • Time Out
                                                                          • Token economy
                                                                          • Slide 113
                                                                          • Slide 114
                                                                          • Slide 115
                                                                          • Intrinsic motivation
                                                                          • Slide 117
                                                                          • Slide 118
                                                                          • Slide 119
                                                                          • Metacognition
                                                                          • ldquoLend Me Your Brainrdquo
                                                                          • What Does Dopamine Feel Like
                                                                          • Preferred States What Does Dopamine Feel Like
                                                                          • Slide 124
                                                                          • PREFERRED STATES INVENTORY
                                                                          • PREFERRED STATES INVENTORY (2)
                                                                          • PREFERRED STATES INVENTORY (3)
                                                                          • Slide 128
                                                                          • Slide 129
                                                                          • Broaden and Build
                                                                          • ldquoNeuroMalleabilityrdquo
                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                          • The reward-and-planning system
                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                          • The reward-and-planning system (2)
                                                                          • Ways the reward-and-planning system can go wrong
                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                          • Slide 141
                                                                          • Lend Me Your Brain
                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                          • Slide 146
                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                          • Slide 149
                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                          • Slide 152
                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                          • Slide 154
                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                          • Slide 157
                                                                          • Slide 158
                                                                          • Slide 159
                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                          • Slide 162
                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                          • Slide 164
                                                                          • Instant gratification vs executive gratification
                                                                          • Slide 166
                                                                          • Slide 167
                                                                          • Slide 168
                                                                          • Slide 169
                                                                          • Slide 170
                                                                          • Self-Talk Proficiency
                                                                          • Self-Talk Proficiency (2)
                                                                          • Self-Talk Proficiency (3)
                                                                          • Self-Talk Proficiency (4)
                                                                          • Match the Picture
                                                                          • Slide 176
                                                                          • Slide 177
                                                                          • Distraction Delay Training
                                                                          • Slide 179
                                                                          • Slide 180
                                                                          • Executive Estimates Training
                                                                          • Learning Time
                                                                          • Learning Time (2)
                                                                          • Learning Time (3)
                                                                          • Slide 185
                                                                          • Slide 186
                                                                          • Learning Time (4)
                                                                          • Asking two questionshellip
                                                                          • Slide 189
                                                                          • Slide 190
                                                                          • Key Features of Video Games
                                                                          • Key Features of Video Games (2)
                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                          • Slide 194
                                                                          • Slide 195
                                                                          • Slide 196
                                                                          • Slide 197
                                                                          • Slide 198
                                                                          • Slide 199
                                                                          • Slide 200
                                                                          • Slide 201
                                                                          • Quarterly QI review
                                                                          • The post-mortem
                                                                          • Slide 204
                                                                          • Slide 205
                                                                          • Slide 206
                                                                          • Slide 207
                                                                          • Slide 208
                                                                          • Slide 209
                                                                          • Slide 210
                                                                          • The ldquoBig Fiverdquo
                                                                          • Slide 212
                                                                          • Slide 213
                                                                          • The ldquoBig Fiverdquo (2)
                                                                          • Slide 215
                                                                          • Slide 216
                                                                          • Slide 217
                                                                          • The ldquoBig Fiverdquo (3)
                                                                          • The ldquoBig Fiverdquo (4)
                                                                          • The ldquoBig Fiverdquo (5)
                                                                          • A challengehellip
                                                                          • Slide 222

                                                                            Functional impact of core symptoms

                                                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                            Functional impact of core symptoms

                                                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                            Functional impact of core symptoms

                                                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                            Functional impact of core symptoms

                                                                            Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                            Functional impact of core symptoms

                                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                            Functional impact of core symptoms

                                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                            Functional impact of core symptoms

                                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                            Functional impact of core symptoms

                                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                            Functional impact of core symptoms

                                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                            Subtypes of ADHD

                                                                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                            Subtypes of ADHD

                                                                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                            Specifed

                                                                            Common comorbidities with ADHD

                                                                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                            processing challenges

                                                                            Common comorbidities with ADHD

                                                                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                            processing challenges

                                                                            ADHD and girls

                                                                            ADHD and women

                                                                            ADHD and women

                                                                            More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                            partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                            disorganization

                                                                            Executive FunctioningAn Overarching Theme

                                                                            Sensory Processing Disorder Central Auditory Processing

                                                                            Disorder ADHD and Executive Dysfunction

                                                                            The Executive Functions

                                                                            Internalizing speech Previewing

                                                                            Prioritizing Tempo control Inhibition

                                                                            The Executive Functions

                                                                            Determining salience (whatrsquos in it for me)

                                                                            Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                            Appropriate expectations

                                                                            Age-appropriate expectations

                                                                            Preschool 1-step errands Chores with cues Basic inhibition

                                                                            Age-appropriate expectations

                                                                            K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                            3rd ndash 5th

                                                                            Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                            Age-appropriate expectations

                                                                            6th ndash 8th

                                                                            complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                            Age-appropriate expectations

                                                                            Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                            already made Take othersrsquo perspective

                                                                            Age-appropriate expectations

                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                            Inter-connectedness of systems Cortico-striatal system for example

                                                                            Strategies

                                                                            Pharmacotherapy

                                                                            X

                                                                            Behavioral Supports

                                                                            A B C

                                                                            A B C

                                                                            behavior

                                                                            A B C

                                                                            consequences

                                                                            A B C

                                                                            antecedent

                                                                            A B C

                                                                            A B C

                                                                            antecedent

                                                                            A B C

                                                                            antecedent

                                                                            easy hard

                                                                            A B C

                                                                            consequences

                                                                            R P

                                                                            +

                                                                            -

                                                                            R+ P+

                                                                            R- P-

                                                                            Time Out

                                                                            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                            Token economy

                                                                            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                            Intrinsic motivation

                                                                            A B C

                                                                            consequencesX

                                                                            A B C

                                                                            behavior

                                                                            Metacognition

                                                                            Metacognitive knowledge Metacognitive strategies

                                                                            ldquoLend Me Your Brainrdquo

                                                                            What Does Dopamine Feel Like

                                                                            The Physiology of Motivation and Reward

                                                                            Preferred States What Does Dopamine Feel Like

                                                                            1 Great experience2 Kodak moment3 The feeeeling

                                                                            David D Nowell PhD189 May Street

                                                                            Worcester Mass 01602DrNowellcom

                                                                            PREFERRED STATES INVENTORY

                                                                            wwwLulucom

                                                                            Identify 20 peak experiences For each peak experience identify the

                                                                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                            of that moment Name it Check the 20 peak moment-feelings for

                                                                            clusters groupings There will probably be 4 or 5

                                                                            PREFERRED STATES INVENTORY

                                                                            Find a word a label for each of the groupings

                                                                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                            ldquovaluesrdquo ways that you really like to feel

                                                                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                            PREFERRED STATES INVENTORY

                                                                            PREFERRED STATES INVENTORY

                                                                            Broaden and Build

                                                                            ldquoNeuroMalleabilityrdquo

                                                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                            The reward-and-planning system

                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                            The reward-and-planning system

                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                            Lend Me Your Brain

                                                                            Supporting Clients with Executive Dysfunction

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                            Too busy with current activity

                                                                            Field dependent

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Sequence problem-solve

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Block out distractions

                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                            - E Goldberg

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Get the reward

                                                                            Ways the reward-and-planning system can go wrong

                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                            Instant gratification vs

                                                                            executive gratification

                                                                            A B C

                                                                            behaviorx

                                                                            Self-Talk Proficiency

                                                                            Self-Talk Proficiency

                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                            takerdquordquo

                                                                            Self-Talk Proficiency

                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                            Self-Talk Proficiency

                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                            thathelliprdquo

                                                                            Match the Picture

                                                                            Distraction Delay Training

                                                                            Executive Estimates Training

                                                                            X

                                                                            Learning Time

                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                            Learning Time

                                                                            Learning Time

                                                                            Learning Time

                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                            Asking two questionshellip

                                                                            Am I having fun now And is this what I set out to do

                                                                            Am I having fun nowIs

                                                                            this

                                                                            what

                                                                            I se

                                                                            t out

                                                                            to

                                                                            do

                                                                            bullYesbullYes

                                                                            bullNobullYes

                                                                            bullYesbullNo

                                                                            bullNobullNo

                                                                            Am I having fun nowIs

                                                                            this

                                                                            what

                                                                            I se

                                                                            t out

                                                                            to

                                                                            do

                                                                            bullFunbullOn-task

                                                                            bullNot funbullOn-task

                                                                            bullFunbullNot on-task

                                                                            bullNot funbullNot on-task

                                                                            Key Features of Video Games

                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                            inappropriate behavior ndash never reverse this

                                                                            Key Features of Video Games

                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                            Volkow et al 2004

                                                                            Increase salience

                                                                            Increase salience

                                                                            Quarterly QI review

                                                                            The post-mortem

                                                                            Your 1 Organizational Tool

                                                                            Your 1 Organizational Tool

                                                                            Yoga read

                                                                            Staff meeting

                                                                            Planningsession

                                                                            Phone calls

                                                                            billing

                                                                            Your 1 Organizational Tool

                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                            Your 1 Organizational Tool

                                                                            Learn French

                                                                            Stop smoking

                                                                            Be a better spouse

                                                                            The ldquoBig Fiverdquo

                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                            The ldquoBig Fiverdquo

                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                            The ldquoBig Fiverdquo

                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                            The ldquoBig Fiverdquo

                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                            The ldquoBig Fiverdquo

                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                            A CHALLENGEhellip

                                                                            wwwDrNowellcom

                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                            DavidNowellSeminars

                                                                            DavidNowell

                                                                            • Slide 1
                                                                            • hellipa challenge
                                                                            • Slide 3
                                                                            • Perspective of this workshophellip
                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                            • ldquoBottom - uprdquo dysfunction
                                                                            • Slide 7
                                                                            • Whatrsquos the kidrsquos deal
                                                                            • Overview
                                                                            • This Dense Pudding
                                                                            • Sensory Processing Disorder
                                                                            • Slide 12
                                                                            • Slide 13
                                                                            • Developmental considerations
                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                            • Slide 17
                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                            • Slide 19
                                                                            • Strategies
                                                                            • Regulatory-Sensory Processing Disorders
                                                                            • Slide 22
                                                                            • Slide 23
                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                            • Slide 25
                                                                            • Central Auditory Processing Disorder
                                                                            • Slide 27
                                                                            • Slide 28
                                                                            • Slide 29
                                                                            • Central Auditory Processing Disorder (2)
                                                                            • Central Auditory Processing Disorder (3)
                                                                            • Central Auditory Processing Disorder (4)
                                                                            • CAPD or ADHD
                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                            • Slide 35
                                                                            • Strategies (2)
                                                                            • (C)APD
                                                                            • Treatment for CAPD
                                                                            • Treatment for CAPD (2)
                                                                            • Self-assessment
                                                                            • Attention Deficit Hyperactivity Disorder
                                                                            • Slide 42
                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                            • (85 ndash X) x 365
                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                            • Core symptoms
                                                                            • Core symptoms (2)
                                                                            • hellipand the rest of the criteria
                                                                            • Slide 49
                                                                            • Functional impact of core symptoms
                                                                            • Functional impact of core symptoms (2)
                                                                            • Functional impact of core symptoms (3)
                                                                            • Slide 53
                                                                            • Functional impact of core symptoms (4)
                                                                            • Functional impact of core symptoms (5)
                                                                            • Functional impact of core symptoms (6)
                                                                            • Functional impact of core symptoms (7)
                                                                            • Functional impact of core symptoms (8)
                                                                            • Functional impact of core symptoms (9)
                                                                            • Subtypes of ADHD
                                                                            • Subtypes of ADHD (2)
                                                                            • Common comorbidities with ADHD
                                                                            • Slide 63
                                                                            • Common comorbidities with ADHD (2)
                                                                            • ADHD and girls
                                                                            • Slide 66
                                                                            • Slide 67
                                                                            • ADHD and women
                                                                            • Slide 69
                                                                            • ADHD and women (2)
                                                                            • Executive Functioning An Overarching Theme
                                                                            • The Executive Functions
                                                                            • The Executive Functions (2)
                                                                            • Slide 74
                                                                            • Slide 75
                                                                            • Appropriate expectations
                                                                            • Age-appropriate expectations
                                                                            • Age-appropriate expectations (2)
                                                                            • Age-appropriate expectations (3)
                                                                            • Age-appropriate expectations (4)
                                                                            • Age-appropriate expectations (5)
                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                            • Slide 84
                                                                            • Slide 85
                                                                            • Strategies (3)
                                                                            • Pharmacotherapy
                                                                            • Behavioral Supports
                                                                            • Slide 89
                                                                            • Slide 90
                                                                            • Slide 91
                                                                            • Slide 92
                                                                            • Slide 93
                                                                            • Slide 94
                                                                            • Slide 95
                                                                            • Slide 96
                                                                            • Slide 97
                                                                            • Slide 98
                                                                            • Slide 99
                                                                            • Slide 100
                                                                            • Slide 101
                                                                            • Slide 102
                                                                            • Slide 103
                                                                            • Slide 104
                                                                            • Slide 105
                                                                            • Slide 106
                                                                            • Slide 107
                                                                            • Slide 108
                                                                            • Slide 109
                                                                            • Slide 110
                                                                            • Time Out
                                                                            • Token economy
                                                                            • Slide 113
                                                                            • Slide 114
                                                                            • Slide 115
                                                                            • Intrinsic motivation
                                                                            • Slide 117
                                                                            • Slide 118
                                                                            • Slide 119
                                                                            • Metacognition
                                                                            • ldquoLend Me Your Brainrdquo
                                                                            • What Does Dopamine Feel Like
                                                                            • Preferred States What Does Dopamine Feel Like
                                                                            • Slide 124
                                                                            • PREFERRED STATES INVENTORY
                                                                            • PREFERRED STATES INVENTORY (2)
                                                                            • PREFERRED STATES INVENTORY (3)
                                                                            • Slide 128
                                                                            • Slide 129
                                                                            • Broaden and Build
                                                                            • ldquoNeuroMalleabilityrdquo
                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                            • The reward-and-planning system
                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                            • The reward-and-planning system (2)
                                                                            • Ways the reward-and-planning system can go wrong
                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                            • Slide 141
                                                                            • Lend Me Your Brain
                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                            • Slide 146
                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                            • Slide 149
                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                            • Slide 152
                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                            • Slide 154
                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                            • Slide 157
                                                                            • Slide 158
                                                                            • Slide 159
                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                            • Slide 162
                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                            • Slide 164
                                                                            • Instant gratification vs executive gratification
                                                                            • Slide 166
                                                                            • Slide 167
                                                                            • Slide 168
                                                                            • Slide 169
                                                                            • Slide 170
                                                                            • Self-Talk Proficiency
                                                                            • Self-Talk Proficiency (2)
                                                                            • Self-Talk Proficiency (3)
                                                                            • Self-Talk Proficiency (4)
                                                                            • Match the Picture
                                                                            • Slide 176
                                                                            • Slide 177
                                                                            • Distraction Delay Training
                                                                            • Slide 179
                                                                            • Slide 180
                                                                            • Executive Estimates Training
                                                                            • Learning Time
                                                                            • Learning Time (2)
                                                                            • Learning Time (3)
                                                                            • Slide 185
                                                                            • Slide 186
                                                                            • Learning Time (4)
                                                                            • Asking two questionshellip
                                                                            • Slide 189
                                                                            • Slide 190
                                                                            • Key Features of Video Games
                                                                            • Key Features of Video Games (2)
                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                            • Slide 194
                                                                            • Slide 195
                                                                            • Slide 196
                                                                            • Slide 197
                                                                            • Slide 198
                                                                            • Slide 199
                                                                            • Slide 200
                                                                            • Slide 201
                                                                            • Quarterly QI review
                                                                            • The post-mortem
                                                                            • Slide 204
                                                                            • Slide 205
                                                                            • Slide 206
                                                                            • Slide 207
                                                                            • Slide 208
                                                                            • Slide 209
                                                                            • Slide 210
                                                                            • The ldquoBig Fiverdquo
                                                                            • Slide 212
                                                                            • Slide 213
                                                                            • The ldquoBig Fiverdquo (2)
                                                                            • Slide 215
                                                                            • Slide 216
                                                                            • Slide 217
                                                                            • The ldquoBig Fiverdquo (3)
                                                                            • The ldquoBig Fiverdquo (4)
                                                                            • The ldquoBig Fiverdquo (5)
                                                                            • A challengehellip
                                                                            • Slide 222

                                                                              Functional impact of core symptoms

                                                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                              Functional impact of core symptoms

                                                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                              Functional impact of core symptoms

                                                                              Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                              Functional impact of core symptoms

                                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                              Functional impact of core symptoms

                                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                              Functional impact of core symptoms

                                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                              Functional impact of core symptoms

                                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                              Functional impact of core symptoms

                                                                              Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                              Subtypes of ADHD

                                                                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                              Subtypes of ADHD

                                                                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                              Specifed

                                                                              Common comorbidities with ADHD

                                                                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                              processing challenges

                                                                              Common comorbidities with ADHD

                                                                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                              processing challenges

                                                                              ADHD and girls

                                                                              ADHD and women

                                                                              ADHD and women

                                                                              More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                              partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                              disorganization

                                                                              Executive FunctioningAn Overarching Theme

                                                                              Sensory Processing Disorder Central Auditory Processing

                                                                              Disorder ADHD and Executive Dysfunction

                                                                              The Executive Functions

                                                                              Internalizing speech Previewing

                                                                              Prioritizing Tempo control Inhibition

                                                                              The Executive Functions

                                                                              Determining salience (whatrsquos in it for me)

                                                                              Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                              Appropriate expectations

                                                                              Age-appropriate expectations

                                                                              Preschool 1-step errands Chores with cues Basic inhibition

                                                                              Age-appropriate expectations

                                                                              K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                              3rd ndash 5th

                                                                              Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                              Age-appropriate expectations

                                                                              6th ndash 8th

                                                                              complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                              Age-appropriate expectations

                                                                              Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                              already made Take othersrsquo perspective

                                                                              Age-appropriate expectations

                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                              Inter-connectedness of systems Cortico-striatal system for example

                                                                              Strategies

                                                                              Pharmacotherapy

                                                                              X

                                                                              Behavioral Supports

                                                                              A B C

                                                                              A B C

                                                                              behavior

                                                                              A B C

                                                                              consequences

                                                                              A B C

                                                                              antecedent

                                                                              A B C

                                                                              A B C

                                                                              antecedent

                                                                              A B C

                                                                              antecedent

                                                                              easy hard

                                                                              A B C

                                                                              consequences

                                                                              R P

                                                                              +

                                                                              -

                                                                              R+ P+

                                                                              R- P-

                                                                              Time Out

                                                                              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                              Token economy

                                                                              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                              Intrinsic motivation

                                                                              A B C

                                                                              consequencesX

                                                                              A B C

                                                                              behavior

                                                                              Metacognition

                                                                              Metacognitive knowledge Metacognitive strategies

                                                                              ldquoLend Me Your Brainrdquo

                                                                              What Does Dopamine Feel Like

                                                                              The Physiology of Motivation and Reward

                                                                              Preferred States What Does Dopamine Feel Like

                                                                              1 Great experience2 Kodak moment3 The feeeeling

                                                                              David D Nowell PhD189 May Street

                                                                              Worcester Mass 01602DrNowellcom

                                                                              PREFERRED STATES INVENTORY

                                                                              wwwLulucom

                                                                              Identify 20 peak experiences For each peak experience identify the

                                                                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                              of that moment Name it Check the 20 peak moment-feelings for

                                                                              clusters groupings There will probably be 4 or 5

                                                                              PREFERRED STATES INVENTORY

                                                                              Find a word a label for each of the groupings

                                                                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                              ldquovaluesrdquo ways that you really like to feel

                                                                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                              PREFERRED STATES INVENTORY

                                                                              PREFERRED STATES INVENTORY

                                                                              Broaden and Build

                                                                              ldquoNeuroMalleabilityrdquo

                                                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                              The reward-and-planning system

                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                              The reward-and-planning system

                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                              Lend Me Your Brain

                                                                              Supporting Clients with Executive Dysfunction

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                              Too busy with current activity

                                                                              Field dependent

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Sequence problem-solve

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Block out distractions

                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                              - E Goldberg

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Get the reward

                                                                              Ways the reward-and-planning system can go wrong

                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                              Instant gratification vs

                                                                              executive gratification

                                                                              A B C

                                                                              behaviorx

                                                                              Self-Talk Proficiency

                                                                              Self-Talk Proficiency

                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                              takerdquordquo

                                                                              Self-Talk Proficiency

                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                              Self-Talk Proficiency

                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                              thathelliprdquo

                                                                              Match the Picture

                                                                              Distraction Delay Training

                                                                              Executive Estimates Training

                                                                              X

                                                                              Learning Time

                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                              Learning Time

                                                                              Learning Time

                                                                              Learning Time

                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                              Asking two questionshellip

                                                                              Am I having fun now And is this what I set out to do

                                                                              Am I having fun nowIs

                                                                              this

                                                                              what

                                                                              I se

                                                                              t out

                                                                              to

                                                                              do

                                                                              bullYesbullYes

                                                                              bullNobullYes

                                                                              bullYesbullNo

                                                                              bullNobullNo

                                                                              Am I having fun nowIs

                                                                              this

                                                                              what

                                                                              I se

                                                                              t out

                                                                              to

                                                                              do

                                                                              bullFunbullOn-task

                                                                              bullNot funbullOn-task

                                                                              bullFunbullNot on-task

                                                                              bullNot funbullNot on-task

                                                                              Key Features of Video Games

                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                              inappropriate behavior ndash never reverse this

                                                                              Key Features of Video Games

                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                              Volkow et al 2004

                                                                              Increase salience

                                                                              Increase salience

                                                                              Quarterly QI review

                                                                              The post-mortem

                                                                              Your 1 Organizational Tool

                                                                              Your 1 Organizational Tool

                                                                              Yoga read

                                                                              Staff meeting

                                                                              Planningsession

                                                                              Phone calls

                                                                              billing

                                                                              Your 1 Organizational Tool

                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                              Your 1 Organizational Tool

                                                                              Learn French

                                                                              Stop smoking

                                                                              Be a better spouse

                                                                              The ldquoBig Fiverdquo

                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                              The ldquoBig Fiverdquo

                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                              The ldquoBig Fiverdquo

                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                              The ldquoBig Fiverdquo

                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                              The ldquoBig Fiverdquo

                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                              A CHALLENGEhellip

                                                                              wwwDrNowellcom

                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                              DavidNowellSeminars

                                                                              DavidNowell

                                                                              • Slide 1
                                                                              • hellipa challenge
                                                                              • Slide 3
                                                                              • Perspective of this workshophellip
                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                              • ldquoBottom - uprdquo dysfunction
                                                                              • Slide 7
                                                                              • Whatrsquos the kidrsquos deal
                                                                              • Overview
                                                                              • This Dense Pudding
                                                                              • Sensory Processing Disorder
                                                                              • Slide 12
                                                                              • Slide 13
                                                                              • Developmental considerations
                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                              • Slide 17
                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                              • Slide 19
                                                                              • Strategies
                                                                              • Regulatory-Sensory Processing Disorders
                                                                              • Slide 22
                                                                              • Slide 23
                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                              • Slide 25
                                                                              • Central Auditory Processing Disorder
                                                                              • Slide 27
                                                                              • Slide 28
                                                                              • Slide 29
                                                                              • Central Auditory Processing Disorder (2)
                                                                              • Central Auditory Processing Disorder (3)
                                                                              • Central Auditory Processing Disorder (4)
                                                                              • CAPD or ADHD
                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                              • Slide 35
                                                                              • Strategies (2)
                                                                              • (C)APD
                                                                              • Treatment for CAPD
                                                                              • Treatment for CAPD (2)
                                                                              • Self-assessment
                                                                              • Attention Deficit Hyperactivity Disorder
                                                                              • Slide 42
                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                              • (85 ndash X) x 365
                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                              • Core symptoms
                                                                              • Core symptoms (2)
                                                                              • hellipand the rest of the criteria
                                                                              • Slide 49
                                                                              • Functional impact of core symptoms
                                                                              • Functional impact of core symptoms (2)
                                                                              • Functional impact of core symptoms (3)
                                                                              • Slide 53
                                                                              • Functional impact of core symptoms (4)
                                                                              • Functional impact of core symptoms (5)
                                                                              • Functional impact of core symptoms (6)
                                                                              • Functional impact of core symptoms (7)
                                                                              • Functional impact of core symptoms (8)
                                                                              • Functional impact of core symptoms (9)
                                                                              • Subtypes of ADHD
                                                                              • Subtypes of ADHD (2)
                                                                              • Common comorbidities with ADHD
                                                                              • Slide 63
                                                                              • Common comorbidities with ADHD (2)
                                                                              • ADHD and girls
                                                                              • Slide 66
                                                                              • Slide 67
                                                                              • ADHD and women
                                                                              • Slide 69
                                                                              • ADHD and women (2)
                                                                              • Executive Functioning An Overarching Theme
                                                                              • The Executive Functions
                                                                              • The Executive Functions (2)
                                                                              • Slide 74
                                                                              • Slide 75
                                                                              • Appropriate expectations
                                                                              • Age-appropriate expectations
                                                                              • Age-appropriate expectations (2)
                                                                              • Age-appropriate expectations (3)
                                                                              • Age-appropriate expectations (4)
                                                                              • Age-appropriate expectations (5)
                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                              • Slide 84
                                                                              • Slide 85
                                                                              • Strategies (3)
                                                                              • Pharmacotherapy
                                                                              • Behavioral Supports
                                                                              • Slide 89
                                                                              • Slide 90
                                                                              • Slide 91
                                                                              • Slide 92
                                                                              • Slide 93
                                                                              • Slide 94
                                                                              • Slide 95
                                                                              • Slide 96
                                                                              • Slide 97
                                                                              • Slide 98
                                                                              • Slide 99
                                                                              • Slide 100
                                                                              • Slide 101
                                                                              • Slide 102
                                                                              • Slide 103
                                                                              • Slide 104
                                                                              • Slide 105
                                                                              • Slide 106
                                                                              • Slide 107
                                                                              • Slide 108
                                                                              • Slide 109
                                                                              • Slide 110
                                                                              • Time Out
                                                                              • Token economy
                                                                              • Slide 113
                                                                              • Slide 114
                                                                              • Slide 115
                                                                              • Intrinsic motivation
                                                                              • Slide 117
                                                                              • Slide 118
                                                                              • Slide 119
                                                                              • Metacognition
                                                                              • ldquoLend Me Your Brainrdquo
                                                                              • What Does Dopamine Feel Like
                                                                              • Preferred States What Does Dopamine Feel Like
                                                                              • Slide 124
                                                                              • PREFERRED STATES INVENTORY
                                                                              • PREFERRED STATES INVENTORY (2)
                                                                              • PREFERRED STATES INVENTORY (3)
                                                                              • Slide 128
                                                                              • Slide 129
                                                                              • Broaden and Build
                                                                              • ldquoNeuroMalleabilityrdquo
                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                              • The reward-and-planning system
                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                              • The reward-and-planning system (2)
                                                                              • Ways the reward-and-planning system can go wrong
                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                              • Slide 141
                                                                              • Lend Me Your Brain
                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                              • Slide 146
                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                              • Slide 149
                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                              • Slide 152
                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                              • Slide 154
                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                              • Slide 157
                                                                              • Slide 158
                                                                              • Slide 159
                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                              • Slide 162
                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                              • Slide 164
                                                                              • Instant gratification vs executive gratification
                                                                              • Slide 166
                                                                              • Slide 167
                                                                              • Slide 168
                                                                              • Slide 169
                                                                              • Slide 170
                                                                              • Self-Talk Proficiency
                                                                              • Self-Talk Proficiency (2)
                                                                              • Self-Talk Proficiency (3)
                                                                              • Self-Talk Proficiency (4)
                                                                              • Match the Picture
                                                                              • Slide 176
                                                                              • Slide 177
                                                                              • Distraction Delay Training
                                                                              • Slide 179
                                                                              • Slide 180
                                                                              • Executive Estimates Training
                                                                              • Learning Time
                                                                              • Learning Time (2)
                                                                              • Learning Time (3)
                                                                              • Slide 185
                                                                              • Slide 186
                                                                              • Learning Time (4)
                                                                              • Asking two questionshellip
                                                                              • Slide 189
                                                                              • Slide 190
                                                                              • Key Features of Video Games
                                                                              • Key Features of Video Games (2)
                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                              • Slide 194
                                                                              • Slide 195
                                                                              • Slide 196
                                                                              • Slide 197
                                                                              • Slide 198
                                                                              • Slide 199
                                                                              • Slide 200
                                                                              • Slide 201
                                                                              • Quarterly QI review
                                                                              • The post-mortem
                                                                              • Slide 204
                                                                              • Slide 205
                                                                              • Slide 206
                                                                              • Slide 207
                                                                              • Slide 208
                                                                              • Slide 209
                                                                              • Slide 210
                                                                              • The ldquoBig Fiverdquo
                                                                              • Slide 212
                                                                              • Slide 213
                                                                              • The ldquoBig Fiverdquo (2)
                                                                              • Slide 215
                                                                              • Slide 216
                                                                              • Slide 217
                                                                              • The ldquoBig Fiverdquo (3)
                                                                              • The ldquoBig Fiverdquo (4)
                                                                              • The ldquoBig Fiverdquo (5)
                                                                              • A challengehellip
                                                                              • Slide 222

                                                                                Functional impact of core symptoms

                                                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                                Functional impact of core symptoms

                                                                                Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                                Functional impact of core symptoms

                                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                Functional impact of core symptoms

                                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                Functional impact of core symptoms

                                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                Functional impact of core symptoms

                                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                Functional impact of core symptoms

                                                                                Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                Subtypes of ADHD

                                                                                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                                Subtypes of ADHD

                                                                                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                                Specifed

                                                                                Common comorbidities with ADHD

                                                                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                processing challenges

                                                                                Common comorbidities with ADHD

                                                                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                processing challenges

                                                                                ADHD and girls

                                                                                ADHD and women

                                                                                ADHD and women

                                                                                More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                disorganization

                                                                                Executive FunctioningAn Overarching Theme

                                                                                Sensory Processing Disorder Central Auditory Processing

                                                                                Disorder ADHD and Executive Dysfunction

                                                                                The Executive Functions

                                                                                Internalizing speech Previewing

                                                                                Prioritizing Tempo control Inhibition

                                                                                The Executive Functions

                                                                                Determining salience (whatrsquos in it for me)

                                                                                Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                Appropriate expectations

                                                                                Age-appropriate expectations

                                                                                Preschool 1-step errands Chores with cues Basic inhibition

                                                                                Age-appropriate expectations

                                                                                K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                3rd ndash 5th

                                                                                Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                Age-appropriate expectations

                                                                                6th ndash 8th

                                                                                complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                Age-appropriate expectations

                                                                                Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                already made Take othersrsquo perspective

                                                                                Age-appropriate expectations

                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                Inter-connectedness of systems Cortico-striatal system for example

                                                                                Strategies

                                                                                Pharmacotherapy

                                                                                X

                                                                                Behavioral Supports

                                                                                A B C

                                                                                A B C

                                                                                behavior

                                                                                A B C

                                                                                consequences

                                                                                A B C

                                                                                antecedent

                                                                                A B C

                                                                                A B C

                                                                                antecedent

                                                                                A B C

                                                                                antecedent

                                                                                easy hard

                                                                                A B C

                                                                                consequences

                                                                                R P

                                                                                +

                                                                                -

                                                                                R+ P+

                                                                                R- P-

                                                                                Time Out

                                                                                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                Token economy

                                                                                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                Intrinsic motivation

                                                                                A B C

                                                                                consequencesX

                                                                                A B C

                                                                                behavior

                                                                                Metacognition

                                                                                Metacognitive knowledge Metacognitive strategies

                                                                                ldquoLend Me Your Brainrdquo

                                                                                What Does Dopamine Feel Like

                                                                                The Physiology of Motivation and Reward

                                                                                Preferred States What Does Dopamine Feel Like

                                                                                1 Great experience2 Kodak moment3 The feeeeling

                                                                                David D Nowell PhD189 May Street

                                                                                Worcester Mass 01602DrNowellcom

                                                                                PREFERRED STATES INVENTORY

                                                                                wwwLulucom

                                                                                Identify 20 peak experiences For each peak experience identify the

                                                                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                of that moment Name it Check the 20 peak moment-feelings for

                                                                                clusters groupings There will probably be 4 or 5

                                                                                PREFERRED STATES INVENTORY

                                                                                Find a word a label for each of the groupings

                                                                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                ldquovaluesrdquo ways that you really like to feel

                                                                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                PREFERRED STATES INVENTORY

                                                                                PREFERRED STATES INVENTORY

                                                                                Broaden and Build

                                                                                ldquoNeuroMalleabilityrdquo

                                                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                The reward-and-planning system

                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                The reward-and-planning system

                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                Lend Me Your Brain

                                                                                Supporting Clients with Executive Dysfunction

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                Too busy with current activity

                                                                                Field dependent

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Sequence problem-solve

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Block out distractions

                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                - E Goldberg

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Get the reward

                                                                                Ways the reward-and-planning system can go wrong

                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                Instant gratification vs

                                                                                executive gratification

                                                                                A B C

                                                                                behaviorx

                                                                                Self-Talk Proficiency

                                                                                Self-Talk Proficiency

                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                takerdquordquo

                                                                                Self-Talk Proficiency

                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                Self-Talk Proficiency

                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                thathelliprdquo

                                                                                Match the Picture

                                                                                Distraction Delay Training

                                                                                Executive Estimates Training

                                                                                X

                                                                                Learning Time

                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                Learning Time

                                                                                Learning Time

                                                                                Learning Time

                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                Asking two questionshellip

                                                                                Am I having fun now And is this what I set out to do

                                                                                Am I having fun nowIs

                                                                                this

                                                                                what

                                                                                I se

                                                                                t out

                                                                                to

                                                                                do

                                                                                bullYesbullYes

                                                                                bullNobullYes

                                                                                bullYesbullNo

                                                                                bullNobullNo

                                                                                Am I having fun nowIs

                                                                                this

                                                                                what

                                                                                I se

                                                                                t out

                                                                                to

                                                                                do

                                                                                bullFunbullOn-task

                                                                                bullNot funbullOn-task

                                                                                bullFunbullNot on-task

                                                                                bullNot funbullNot on-task

                                                                                Key Features of Video Games

                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                inappropriate behavior ndash never reverse this

                                                                                Key Features of Video Games

                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                Volkow et al 2004

                                                                                Increase salience

                                                                                Increase salience

                                                                                Quarterly QI review

                                                                                The post-mortem

                                                                                Your 1 Organizational Tool

                                                                                Your 1 Organizational Tool

                                                                                Yoga read

                                                                                Staff meeting

                                                                                Planningsession

                                                                                Phone calls

                                                                                billing

                                                                                Your 1 Organizational Tool

                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                Your 1 Organizational Tool

                                                                                Learn French

                                                                                Stop smoking

                                                                                Be a better spouse

                                                                                The ldquoBig Fiverdquo

                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                The ldquoBig Fiverdquo

                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                The ldquoBig Fiverdquo

                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                The ldquoBig Fiverdquo

                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                The ldquoBig Fiverdquo

                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                A CHALLENGEhellip

                                                                                wwwDrNowellcom

                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                DavidNowellSeminars

                                                                                DavidNowell

                                                                                • Slide 1
                                                                                • hellipa challenge
                                                                                • Slide 3
                                                                                • Perspective of this workshophellip
                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                • Slide 7
                                                                                • Whatrsquos the kidrsquos deal
                                                                                • Overview
                                                                                • This Dense Pudding
                                                                                • Sensory Processing Disorder
                                                                                • Slide 12
                                                                                • Slide 13
                                                                                • Developmental considerations
                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                • Slide 17
                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                • Slide 19
                                                                                • Strategies
                                                                                • Regulatory-Sensory Processing Disorders
                                                                                • Slide 22
                                                                                • Slide 23
                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                • Slide 25
                                                                                • Central Auditory Processing Disorder
                                                                                • Slide 27
                                                                                • Slide 28
                                                                                • Slide 29
                                                                                • Central Auditory Processing Disorder (2)
                                                                                • Central Auditory Processing Disorder (3)
                                                                                • Central Auditory Processing Disorder (4)
                                                                                • CAPD or ADHD
                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                • Slide 35
                                                                                • Strategies (2)
                                                                                • (C)APD
                                                                                • Treatment for CAPD
                                                                                • Treatment for CAPD (2)
                                                                                • Self-assessment
                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                • Slide 42
                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                • (85 ndash X) x 365
                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                • Core symptoms
                                                                                • Core symptoms (2)
                                                                                • hellipand the rest of the criteria
                                                                                • Slide 49
                                                                                • Functional impact of core symptoms
                                                                                • Functional impact of core symptoms (2)
                                                                                • Functional impact of core symptoms (3)
                                                                                • Slide 53
                                                                                • Functional impact of core symptoms (4)
                                                                                • Functional impact of core symptoms (5)
                                                                                • Functional impact of core symptoms (6)
                                                                                • Functional impact of core symptoms (7)
                                                                                • Functional impact of core symptoms (8)
                                                                                • Functional impact of core symptoms (9)
                                                                                • Subtypes of ADHD
                                                                                • Subtypes of ADHD (2)
                                                                                • Common comorbidities with ADHD
                                                                                • Slide 63
                                                                                • Common comorbidities with ADHD (2)
                                                                                • ADHD and girls
                                                                                • Slide 66
                                                                                • Slide 67
                                                                                • ADHD and women
                                                                                • Slide 69
                                                                                • ADHD and women (2)
                                                                                • Executive Functioning An Overarching Theme
                                                                                • The Executive Functions
                                                                                • The Executive Functions (2)
                                                                                • Slide 74
                                                                                • Slide 75
                                                                                • Appropriate expectations
                                                                                • Age-appropriate expectations
                                                                                • Age-appropriate expectations (2)
                                                                                • Age-appropriate expectations (3)
                                                                                • Age-appropriate expectations (4)
                                                                                • Age-appropriate expectations (5)
                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                • Slide 84
                                                                                • Slide 85
                                                                                • Strategies (3)
                                                                                • Pharmacotherapy
                                                                                • Behavioral Supports
                                                                                • Slide 89
                                                                                • Slide 90
                                                                                • Slide 91
                                                                                • Slide 92
                                                                                • Slide 93
                                                                                • Slide 94
                                                                                • Slide 95
                                                                                • Slide 96
                                                                                • Slide 97
                                                                                • Slide 98
                                                                                • Slide 99
                                                                                • Slide 100
                                                                                • Slide 101
                                                                                • Slide 102
                                                                                • Slide 103
                                                                                • Slide 104
                                                                                • Slide 105
                                                                                • Slide 106
                                                                                • Slide 107
                                                                                • Slide 108
                                                                                • Slide 109
                                                                                • Slide 110
                                                                                • Time Out
                                                                                • Token economy
                                                                                • Slide 113
                                                                                • Slide 114
                                                                                • Slide 115
                                                                                • Intrinsic motivation
                                                                                • Slide 117
                                                                                • Slide 118
                                                                                • Slide 119
                                                                                • Metacognition
                                                                                • ldquoLend Me Your Brainrdquo
                                                                                • What Does Dopamine Feel Like
                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                • Slide 124
                                                                                • PREFERRED STATES INVENTORY
                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                • Slide 128
                                                                                • Slide 129
                                                                                • Broaden and Build
                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                • The reward-and-planning system
                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                • The reward-and-planning system (2)
                                                                                • Ways the reward-and-planning system can go wrong
                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                • Slide 141
                                                                                • Lend Me Your Brain
                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                • Slide 146
                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                • Slide 149
                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                • Slide 152
                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                • Slide 154
                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                • Slide 157
                                                                                • Slide 158
                                                                                • Slide 159
                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                • Slide 162
                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                • Slide 164
                                                                                • Instant gratification vs executive gratification
                                                                                • Slide 166
                                                                                • Slide 167
                                                                                • Slide 168
                                                                                • Slide 169
                                                                                • Slide 170
                                                                                • Self-Talk Proficiency
                                                                                • Self-Talk Proficiency (2)
                                                                                • Self-Talk Proficiency (3)
                                                                                • Self-Talk Proficiency (4)
                                                                                • Match the Picture
                                                                                • Slide 176
                                                                                • Slide 177
                                                                                • Distraction Delay Training
                                                                                • Slide 179
                                                                                • Slide 180
                                                                                • Executive Estimates Training
                                                                                • Learning Time
                                                                                • Learning Time (2)
                                                                                • Learning Time (3)
                                                                                • Slide 185
                                                                                • Slide 186
                                                                                • Learning Time (4)
                                                                                • Asking two questionshellip
                                                                                • Slide 189
                                                                                • Slide 190
                                                                                • Key Features of Video Games
                                                                                • Key Features of Video Games (2)
                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                • Slide 194
                                                                                • Slide 195
                                                                                • Slide 196
                                                                                • Slide 197
                                                                                • Slide 198
                                                                                • Slide 199
                                                                                • Slide 200
                                                                                • Slide 201
                                                                                • Quarterly QI review
                                                                                • The post-mortem
                                                                                • Slide 204
                                                                                • Slide 205
                                                                                • Slide 206
                                                                                • Slide 207
                                                                                • Slide 208
                                                                                • Slide 209
                                                                                • Slide 210
                                                                                • The ldquoBig Fiverdquo
                                                                                • Slide 212
                                                                                • Slide 213
                                                                                • The ldquoBig Fiverdquo (2)
                                                                                • Slide 215
                                                                                • Slide 216
                                                                                • Slide 217
                                                                                • The ldquoBig Fiverdquo (3)
                                                                                • The ldquoBig Fiverdquo (4)
                                                                                • The ldquoBig Fiverdquo (5)
                                                                                • A challengehellip
                                                                                • Slide 222

                                                                                  Functional impact of core symptoms

                                                                                  Arousal alertness Mental effort Determination of saliency Focal maintenance

                                                                                  Functional impact of core symptoms

                                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                  Functional impact of core symptoms

                                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                  Functional impact of core symptoms

                                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                  Functional impact of core symptoms

                                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                  Functional impact of core symptoms

                                                                                  Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                  Subtypes of ADHD

                                                                                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                                  Subtypes of ADHD

                                                                                  ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                                  Specifed

                                                                                  Common comorbidities with ADHD

                                                                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                  processing challenges

                                                                                  Common comorbidities with ADHD

                                                                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                  processing challenges

                                                                                  ADHD and girls

                                                                                  ADHD and women

                                                                                  ADHD and women

                                                                                  More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                  partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                  disorganization

                                                                                  Executive FunctioningAn Overarching Theme

                                                                                  Sensory Processing Disorder Central Auditory Processing

                                                                                  Disorder ADHD and Executive Dysfunction

                                                                                  The Executive Functions

                                                                                  Internalizing speech Previewing

                                                                                  Prioritizing Tempo control Inhibition

                                                                                  The Executive Functions

                                                                                  Determining salience (whatrsquos in it for me)

                                                                                  Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                  Appropriate expectations

                                                                                  Age-appropriate expectations

                                                                                  Preschool 1-step errands Chores with cues Basic inhibition

                                                                                  Age-appropriate expectations

                                                                                  K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                  3rd ndash 5th

                                                                                  Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                  Age-appropriate expectations

                                                                                  6th ndash 8th

                                                                                  complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                  Age-appropriate expectations

                                                                                  Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                  already made Take othersrsquo perspective

                                                                                  Age-appropriate expectations

                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                  Inter-connectedness of systems Cortico-striatal system for example

                                                                                  Strategies

                                                                                  Pharmacotherapy

                                                                                  X

                                                                                  Behavioral Supports

                                                                                  A B C

                                                                                  A B C

                                                                                  behavior

                                                                                  A B C

                                                                                  consequences

                                                                                  A B C

                                                                                  antecedent

                                                                                  A B C

                                                                                  A B C

                                                                                  antecedent

                                                                                  A B C

                                                                                  antecedent

                                                                                  easy hard

                                                                                  A B C

                                                                                  consequences

                                                                                  R P

                                                                                  +

                                                                                  -

                                                                                  R+ P+

                                                                                  R- P-

                                                                                  Time Out

                                                                                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                  Token economy

                                                                                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                  Intrinsic motivation

                                                                                  A B C

                                                                                  consequencesX

                                                                                  A B C

                                                                                  behavior

                                                                                  Metacognition

                                                                                  Metacognitive knowledge Metacognitive strategies

                                                                                  ldquoLend Me Your Brainrdquo

                                                                                  What Does Dopamine Feel Like

                                                                                  The Physiology of Motivation and Reward

                                                                                  Preferred States What Does Dopamine Feel Like

                                                                                  1 Great experience2 Kodak moment3 The feeeeling

                                                                                  David D Nowell PhD189 May Street

                                                                                  Worcester Mass 01602DrNowellcom

                                                                                  PREFERRED STATES INVENTORY

                                                                                  wwwLulucom

                                                                                  Identify 20 peak experiences For each peak experience identify the

                                                                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                  of that moment Name it Check the 20 peak moment-feelings for

                                                                                  clusters groupings There will probably be 4 or 5

                                                                                  PREFERRED STATES INVENTORY

                                                                                  Find a word a label for each of the groupings

                                                                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                  ldquovaluesrdquo ways that you really like to feel

                                                                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                  PREFERRED STATES INVENTORY

                                                                                  PREFERRED STATES INVENTORY

                                                                                  Broaden and Build

                                                                                  ldquoNeuroMalleabilityrdquo

                                                                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                  The reward-and-planning system

                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                  The reward-and-planning system

                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                  Lend Me Your Brain

                                                                                  Supporting Clients with Executive Dysfunction

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                  Too busy with current activity

                                                                                  Field dependent

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Sequence problem-solve

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Block out distractions

                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                  - E Goldberg

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Get the reward

                                                                                  Ways the reward-and-planning system can go wrong

                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                  Instant gratification vs

                                                                                  executive gratification

                                                                                  A B C

                                                                                  behaviorx

                                                                                  Self-Talk Proficiency

                                                                                  Self-Talk Proficiency

                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                  takerdquordquo

                                                                                  Self-Talk Proficiency

                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                  Self-Talk Proficiency

                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                  thathelliprdquo

                                                                                  Match the Picture

                                                                                  Distraction Delay Training

                                                                                  Executive Estimates Training

                                                                                  X

                                                                                  Learning Time

                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                  Learning Time

                                                                                  Learning Time

                                                                                  Learning Time

                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                  Asking two questionshellip

                                                                                  Am I having fun now And is this what I set out to do

                                                                                  Am I having fun nowIs

                                                                                  this

                                                                                  what

                                                                                  I se

                                                                                  t out

                                                                                  to

                                                                                  do

                                                                                  bullYesbullYes

                                                                                  bullNobullYes

                                                                                  bullYesbullNo

                                                                                  bullNobullNo

                                                                                  Am I having fun nowIs

                                                                                  this

                                                                                  what

                                                                                  I se

                                                                                  t out

                                                                                  to

                                                                                  do

                                                                                  bullFunbullOn-task

                                                                                  bullNot funbullOn-task

                                                                                  bullFunbullNot on-task

                                                                                  bullNot funbullNot on-task

                                                                                  Key Features of Video Games

                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                  inappropriate behavior ndash never reverse this

                                                                                  Key Features of Video Games

                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                  Volkow et al 2004

                                                                                  Increase salience

                                                                                  Increase salience

                                                                                  Quarterly QI review

                                                                                  The post-mortem

                                                                                  Your 1 Organizational Tool

                                                                                  Your 1 Organizational Tool

                                                                                  Yoga read

                                                                                  Staff meeting

                                                                                  Planningsession

                                                                                  Phone calls

                                                                                  billing

                                                                                  Your 1 Organizational Tool

                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                  Your 1 Organizational Tool

                                                                                  Learn French

                                                                                  Stop smoking

                                                                                  Be a better spouse

                                                                                  The ldquoBig Fiverdquo

                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                  The ldquoBig Fiverdquo

                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                  The ldquoBig Fiverdquo

                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                  The ldquoBig Fiverdquo

                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                  The ldquoBig Fiverdquo

                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                  A CHALLENGEhellip

                                                                                  wwwDrNowellcom

                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                  DavidNowellSeminars

                                                                                  DavidNowell

                                                                                  • Slide 1
                                                                                  • hellipa challenge
                                                                                  • Slide 3
                                                                                  • Perspective of this workshophellip
                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                  • Slide 7
                                                                                  • Whatrsquos the kidrsquos deal
                                                                                  • Overview
                                                                                  • This Dense Pudding
                                                                                  • Sensory Processing Disorder
                                                                                  • Slide 12
                                                                                  • Slide 13
                                                                                  • Developmental considerations
                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                  • Slide 17
                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                  • Slide 19
                                                                                  • Strategies
                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                  • Slide 22
                                                                                  • Slide 23
                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                  • Slide 25
                                                                                  • Central Auditory Processing Disorder
                                                                                  • Slide 27
                                                                                  • Slide 28
                                                                                  • Slide 29
                                                                                  • Central Auditory Processing Disorder (2)
                                                                                  • Central Auditory Processing Disorder (3)
                                                                                  • Central Auditory Processing Disorder (4)
                                                                                  • CAPD or ADHD
                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                  • Slide 35
                                                                                  • Strategies (2)
                                                                                  • (C)APD
                                                                                  • Treatment for CAPD
                                                                                  • Treatment for CAPD (2)
                                                                                  • Self-assessment
                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                  • Slide 42
                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                  • (85 ndash X) x 365
                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                  • Core symptoms
                                                                                  • Core symptoms (2)
                                                                                  • hellipand the rest of the criteria
                                                                                  • Slide 49
                                                                                  • Functional impact of core symptoms
                                                                                  • Functional impact of core symptoms (2)
                                                                                  • Functional impact of core symptoms (3)
                                                                                  • Slide 53
                                                                                  • Functional impact of core symptoms (4)
                                                                                  • Functional impact of core symptoms (5)
                                                                                  • Functional impact of core symptoms (6)
                                                                                  • Functional impact of core symptoms (7)
                                                                                  • Functional impact of core symptoms (8)
                                                                                  • Functional impact of core symptoms (9)
                                                                                  • Subtypes of ADHD
                                                                                  • Subtypes of ADHD (2)
                                                                                  • Common comorbidities with ADHD
                                                                                  • Slide 63
                                                                                  • Common comorbidities with ADHD (2)
                                                                                  • ADHD and girls
                                                                                  • Slide 66
                                                                                  • Slide 67
                                                                                  • ADHD and women
                                                                                  • Slide 69
                                                                                  • ADHD and women (2)
                                                                                  • Executive Functioning An Overarching Theme
                                                                                  • The Executive Functions
                                                                                  • The Executive Functions (2)
                                                                                  • Slide 74
                                                                                  • Slide 75
                                                                                  • Appropriate expectations
                                                                                  • Age-appropriate expectations
                                                                                  • Age-appropriate expectations (2)
                                                                                  • Age-appropriate expectations (3)
                                                                                  • Age-appropriate expectations (4)
                                                                                  • Age-appropriate expectations (5)
                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                  • Slide 84
                                                                                  • Slide 85
                                                                                  • Strategies (3)
                                                                                  • Pharmacotherapy
                                                                                  • Behavioral Supports
                                                                                  • Slide 89
                                                                                  • Slide 90
                                                                                  • Slide 91
                                                                                  • Slide 92
                                                                                  • Slide 93
                                                                                  • Slide 94
                                                                                  • Slide 95
                                                                                  • Slide 96
                                                                                  • Slide 97
                                                                                  • Slide 98
                                                                                  • Slide 99
                                                                                  • Slide 100
                                                                                  • Slide 101
                                                                                  • Slide 102
                                                                                  • Slide 103
                                                                                  • Slide 104
                                                                                  • Slide 105
                                                                                  • Slide 106
                                                                                  • Slide 107
                                                                                  • Slide 108
                                                                                  • Slide 109
                                                                                  • Slide 110
                                                                                  • Time Out
                                                                                  • Token economy
                                                                                  • Slide 113
                                                                                  • Slide 114
                                                                                  • Slide 115
                                                                                  • Intrinsic motivation
                                                                                  • Slide 117
                                                                                  • Slide 118
                                                                                  • Slide 119
                                                                                  • Metacognition
                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                  • What Does Dopamine Feel Like
                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                  • Slide 124
                                                                                  • PREFERRED STATES INVENTORY
                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                  • Slide 128
                                                                                  • Slide 129
                                                                                  • Broaden and Build
                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                  • The reward-and-planning system
                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                  • The reward-and-planning system (2)
                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                  • Slide 141
                                                                                  • Lend Me Your Brain
                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                  • Slide 146
                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                  • Slide 149
                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                  • Slide 152
                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                  • Slide 154
                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                  • Slide 157
                                                                                  • Slide 158
                                                                                  • Slide 159
                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                  • Slide 162
                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                  • Slide 164
                                                                                  • Instant gratification vs executive gratification
                                                                                  • Slide 166
                                                                                  • Slide 167
                                                                                  • Slide 168
                                                                                  • Slide 169
                                                                                  • Slide 170
                                                                                  • Self-Talk Proficiency
                                                                                  • Self-Talk Proficiency (2)
                                                                                  • Self-Talk Proficiency (3)
                                                                                  • Self-Talk Proficiency (4)
                                                                                  • Match the Picture
                                                                                  • Slide 176
                                                                                  • Slide 177
                                                                                  • Distraction Delay Training
                                                                                  • Slide 179
                                                                                  • Slide 180
                                                                                  • Executive Estimates Training
                                                                                  • Learning Time
                                                                                  • Learning Time (2)
                                                                                  • Learning Time (3)
                                                                                  • Slide 185
                                                                                  • Slide 186
                                                                                  • Learning Time (4)
                                                                                  • Asking two questionshellip
                                                                                  • Slide 189
                                                                                  • Slide 190
                                                                                  • Key Features of Video Games
                                                                                  • Key Features of Video Games (2)
                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                  • Slide 194
                                                                                  • Slide 195
                                                                                  • Slide 196
                                                                                  • Slide 197
                                                                                  • Slide 198
                                                                                  • Slide 199
                                                                                  • Slide 200
                                                                                  • Slide 201
                                                                                  • Quarterly QI review
                                                                                  • The post-mortem
                                                                                  • Slide 204
                                                                                  • Slide 205
                                                                                  • Slide 206
                                                                                  • Slide 207
                                                                                  • Slide 208
                                                                                  • Slide 209
                                                                                  • Slide 210
                                                                                  • The ldquoBig Fiverdquo
                                                                                  • Slide 212
                                                                                  • Slide 213
                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                  • Slide 215
                                                                                  • Slide 216
                                                                                  • Slide 217
                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                  • A challengehellip
                                                                                  • Slide 222

                                                                                    Functional impact of core symptoms

                                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                    Functional impact of core symptoms

                                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                    Functional impact of core symptoms

                                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                    Functional impact of core symptoms

                                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                    Functional impact of core symptoms

                                                                                    Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                    Subtypes of ADHD

                                                                                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                                    Subtypes of ADHD

                                                                                    ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                                    Specifed

                                                                                    Common comorbidities with ADHD

                                                                                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                    processing challenges

                                                                                    Common comorbidities with ADHD

                                                                                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                    processing challenges

                                                                                    ADHD and girls

                                                                                    ADHD and women

                                                                                    ADHD and women

                                                                                    More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                    partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                    disorganization

                                                                                    Executive FunctioningAn Overarching Theme

                                                                                    Sensory Processing Disorder Central Auditory Processing

                                                                                    Disorder ADHD and Executive Dysfunction

                                                                                    The Executive Functions

                                                                                    Internalizing speech Previewing

                                                                                    Prioritizing Tempo control Inhibition

                                                                                    The Executive Functions

                                                                                    Determining salience (whatrsquos in it for me)

                                                                                    Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                    Appropriate expectations

                                                                                    Age-appropriate expectations

                                                                                    Preschool 1-step errands Chores with cues Basic inhibition

                                                                                    Age-appropriate expectations

                                                                                    K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                    3rd ndash 5th

                                                                                    Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                    Age-appropriate expectations

                                                                                    6th ndash 8th

                                                                                    complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                    Age-appropriate expectations

                                                                                    Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                    already made Take othersrsquo perspective

                                                                                    Age-appropriate expectations

                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                    Inter-connectedness of systems Cortico-striatal system for example

                                                                                    Strategies

                                                                                    Pharmacotherapy

                                                                                    X

                                                                                    Behavioral Supports

                                                                                    A B C

                                                                                    A B C

                                                                                    behavior

                                                                                    A B C

                                                                                    consequences

                                                                                    A B C

                                                                                    antecedent

                                                                                    A B C

                                                                                    A B C

                                                                                    antecedent

                                                                                    A B C

                                                                                    antecedent

                                                                                    easy hard

                                                                                    A B C

                                                                                    consequences

                                                                                    R P

                                                                                    +

                                                                                    -

                                                                                    R+ P+

                                                                                    R- P-

                                                                                    Time Out

                                                                                    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                    Token economy

                                                                                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                    Intrinsic motivation

                                                                                    A B C

                                                                                    consequencesX

                                                                                    A B C

                                                                                    behavior

                                                                                    Metacognition

                                                                                    Metacognitive knowledge Metacognitive strategies

                                                                                    ldquoLend Me Your Brainrdquo

                                                                                    What Does Dopamine Feel Like

                                                                                    The Physiology of Motivation and Reward

                                                                                    Preferred States What Does Dopamine Feel Like

                                                                                    1 Great experience2 Kodak moment3 The feeeeling

                                                                                    David D Nowell PhD189 May Street

                                                                                    Worcester Mass 01602DrNowellcom

                                                                                    PREFERRED STATES INVENTORY

                                                                                    wwwLulucom

                                                                                    Identify 20 peak experiences For each peak experience identify the

                                                                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                    of that moment Name it Check the 20 peak moment-feelings for

                                                                                    clusters groupings There will probably be 4 or 5

                                                                                    PREFERRED STATES INVENTORY

                                                                                    Find a word a label for each of the groupings

                                                                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                    ldquovaluesrdquo ways that you really like to feel

                                                                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                    PREFERRED STATES INVENTORY

                                                                                    PREFERRED STATES INVENTORY

                                                                                    Broaden and Build

                                                                                    ldquoNeuroMalleabilityrdquo

                                                                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                    The reward-and-planning system

                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                    The reward-and-planning system

                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                    Lend Me Your Brain

                                                                                    Supporting Clients with Executive Dysfunction

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                    Too busy with current activity

                                                                                    Field dependent

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Sequence problem-solve

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Block out distractions

                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                    - E Goldberg

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Get the reward

                                                                                    Ways the reward-and-planning system can go wrong

                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                    Instant gratification vs

                                                                                    executive gratification

                                                                                    A B C

                                                                                    behaviorx

                                                                                    Self-Talk Proficiency

                                                                                    Self-Talk Proficiency

                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                    takerdquordquo

                                                                                    Self-Talk Proficiency

                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                    Self-Talk Proficiency

                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                    thathelliprdquo

                                                                                    Match the Picture

                                                                                    Distraction Delay Training

                                                                                    Executive Estimates Training

                                                                                    X

                                                                                    Learning Time

                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                    Learning Time

                                                                                    Learning Time

                                                                                    Learning Time

                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                    Asking two questionshellip

                                                                                    Am I having fun now And is this what I set out to do

                                                                                    Am I having fun nowIs

                                                                                    this

                                                                                    what

                                                                                    I se

                                                                                    t out

                                                                                    to

                                                                                    do

                                                                                    bullYesbullYes

                                                                                    bullNobullYes

                                                                                    bullYesbullNo

                                                                                    bullNobullNo

                                                                                    Am I having fun nowIs

                                                                                    this

                                                                                    what

                                                                                    I se

                                                                                    t out

                                                                                    to

                                                                                    do

                                                                                    bullFunbullOn-task

                                                                                    bullNot funbullOn-task

                                                                                    bullFunbullNot on-task

                                                                                    bullNot funbullNot on-task

                                                                                    Key Features of Video Games

                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                    inappropriate behavior ndash never reverse this

                                                                                    Key Features of Video Games

                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                    Volkow et al 2004

                                                                                    Increase salience

                                                                                    Increase salience

                                                                                    Quarterly QI review

                                                                                    The post-mortem

                                                                                    Your 1 Organizational Tool

                                                                                    Your 1 Organizational Tool

                                                                                    Yoga read

                                                                                    Staff meeting

                                                                                    Planningsession

                                                                                    Phone calls

                                                                                    billing

                                                                                    Your 1 Organizational Tool

                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                    Your 1 Organizational Tool

                                                                                    Learn French

                                                                                    Stop smoking

                                                                                    Be a better spouse

                                                                                    The ldquoBig Fiverdquo

                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                    The ldquoBig Fiverdquo

                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                    The ldquoBig Fiverdquo

                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                    The ldquoBig Fiverdquo

                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                    The ldquoBig Fiverdquo

                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                    A CHALLENGEhellip

                                                                                    wwwDrNowellcom

                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                    DavidNowellSeminars

                                                                                    DavidNowell

                                                                                    • Slide 1
                                                                                    • hellipa challenge
                                                                                    • Slide 3
                                                                                    • Perspective of this workshophellip
                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                    • Slide 7
                                                                                    • Whatrsquos the kidrsquos deal
                                                                                    • Overview
                                                                                    • This Dense Pudding
                                                                                    • Sensory Processing Disorder
                                                                                    • Slide 12
                                                                                    • Slide 13
                                                                                    • Developmental considerations
                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                    • Slide 17
                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                    • Slide 19
                                                                                    • Strategies
                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                    • Slide 22
                                                                                    • Slide 23
                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                    • Slide 25
                                                                                    • Central Auditory Processing Disorder
                                                                                    • Slide 27
                                                                                    • Slide 28
                                                                                    • Slide 29
                                                                                    • Central Auditory Processing Disorder (2)
                                                                                    • Central Auditory Processing Disorder (3)
                                                                                    • Central Auditory Processing Disorder (4)
                                                                                    • CAPD or ADHD
                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                    • Slide 35
                                                                                    • Strategies (2)
                                                                                    • (C)APD
                                                                                    • Treatment for CAPD
                                                                                    • Treatment for CAPD (2)
                                                                                    • Self-assessment
                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                    • Slide 42
                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                    • (85 ndash X) x 365
                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                    • Core symptoms
                                                                                    • Core symptoms (2)
                                                                                    • hellipand the rest of the criteria
                                                                                    • Slide 49
                                                                                    • Functional impact of core symptoms
                                                                                    • Functional impact of core symptoms (2)
                                                                                    • Functional impact of core symptoms (3)
                                                                                    • Slide 53
                                                                                    • Functional impact of core symptoms (4)
                                                                                    • Functional impact of core symptoms (5)
                                                                                    • Functional impact of core symptoms (6)
                                                                                    • Functional impact of core symptoms (7)
                                                                                    • Functional impact of core symptoms (8)
                                                                                    • Functional impact of core symptoms (9)
                                                                                    • Subtypes of ADHD
                                                                                    • Subtypes of ADHD (2)
                                                                                    • Common comorbidities with ADHD
                                                                                    • Slide 63
                                                                                    • Common comorbidities with ADHD (2)
                                                                                    • ADHD and girls
                                                                                    • Slide 66
                                                                                    • Slide 67
                                                                                    • ADHD and women
                                                                                    • Slide 69
                                                                                    • ADHD and women (2)
                                                                                    • Executive Functioning An Overarching Theme
                                                                                    • The Executive Functions
                                                                                    • The Executive Functions (2)
                                                                                    • Slide 74
                                                                                    • Slide 75
                                                                                    • Appropriate expectations
                                                                                    • Age-appropriate expectations
                                                                                    • Age-appropriate expectations (2)
                                                                                    • Age-appropriate expectations (3)
                                                                                    • Age-appropriate expectations (4)
                                                                                    • Age-appropriate expectations (5)
                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                    • Slide 84
                                                                                    • Slide 85
                                                                                    • Strategies (3)
                                                                                    • Pharmacotherapy
                                                                                    • Behavioral Supports
                                                                                    • Slide 89
                                                                                    • Slide 90
                                                                                    • Slide 91
                                                                                    • Slide 92
                                                                                    • Slide 93
                                                                                    • Slide 94
                                                                                    • Slide 95
                                                                                    • Slide 96
                                                                                    • Slide 97
                                                                                    • Slide 98
                                                                                    • Slide 99
                                                                                    • Slide 100
                                                                                    • Slide 101
                                                                                    • Slide 102
                                                                                    • Slide 103
                                                                                    • Slide 104
                                                                                    • Slide 105
                                                                                    • Slide 106
                                                                                    • Slide 107
                                                                                    • Slide 108
                                                                                    • Slide 109
                                                                                    • Slide 110
                                                                                    • Time Out
                                                                                    • Token economy
                                                                                    • Slide 113
                                                                                    • Slide 114
                                                                                    • Slide 115
                                                                                    • Intrinsic motivation
                                                                                    • Slide 117
                                                                                    • Slide 118
                                                                                    • Slide 119
                                                                                    • Metacognition
                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                    • What Does Dopamine Feel Like
                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                    • Slide 124
                                                                                    • PREFERRED STATES INVENTORY
                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                    • Slide 128
                                                                                    • Slide 129
                                                                                    • Broaden and Build
                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                    • The reward-and-planning system
                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                    • The reward-and-planning system (2)
                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                    • Slide 141
                                                                                    • Lend Me Your Brain
                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                    • Slide 146
                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                    • Slide 149
                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                    • Slide 152
                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                    • Slide 154
                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                    • Slide 157
                                                                                    • Slide 158
                                                                                    • Slide 159
                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                    • Slide 162
                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                    • Slide 164
                                                                                    • Instant gratification vs executive gratification
                                                                                    • Slide 166
                                                                                    • Slide 167
                                                                                    • Slide 168
                                                                                    • Slide 169
                                                                                    • Slide 170
                                                                                    • Self-Talk Proficiency
                                                                                    • Self-Talk Proficiency (2)
                                                                                    • Self-Talk Proficiency (3)
                                                                                    • Self-Talk Proficiency (4)
                                                                                    • Match the Picture
                                                                                    • Slide 176
                                                                                    • Slide 177
                                                                                    • Distraction Delay Training
                                                                                    • Slide 179
                                                                                    • Slide 180
                                                                                    • Executive Estimates Training
                                                                                    • Learning Time
                                                                                    • Learning Time (2)
                                                                                    • Learning Time (3)
                                                                                    • Slide 185
                                                                                    • Slide 186
                                                                                    • Learning Time (4)
                                                                                    • Asking two questionshellip
                                                                                    • Slide 189
                                                                                    • Slide 190
                                                                                    • Key Features of Video Games
                                                                                    • Key Features of Video Games (2)
                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                    • Slide 194
                                                                                    • Slide 195
                                                                                    • Slide 196
                                                                                    • Slide 197
                                                                                    • Slide 198
                                                                                    • Slide 199
                                                                                    • Slide 200
                                                                                    • Slide 201
                                                                                    • Quarterly QI review
                                                                                    • The post-mortem
                                                                                    • Slide 204
                                                                                    • Slide 205
                                                                                    • Slide 206
                                                                                    • Slide 207
                                                                                    • Slide 208
                                                                                    • Slide 209
                                                                                    • Slide 210
                                                                                    • The ldquoBig Fiverdquo
                                                                                    • Slide 212
                                                                                    • Slide 213
                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                    • Slide 215
                                                                                    • Slide 216
                                                                                    • Slide 217
                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                    • A challengehellip
                                                                                    • Slide 222

                                                                                      Functional impact of core symptoms

                                                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                      Functional impact of core symptoms

                                                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                      Functional impact of core symptoms

                                                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                      Functional impact of core symptoms

                                                                                      Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                      Subtypes of ADHD

                                                                                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                                      Subtypes of ADHD

                                                                                      ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                                      Specifed

                                                                                      Common comorbidities with ADHD

                                                                                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                      processing challenges

                                                                                      Common comorbidities with ADHD

                                                                                      Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                      processing challenges

                                                                                      ADHD and girls

                                                                                      ADHD and women

                                                                                      ADHD and women

                                                                                      More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                      partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                      disorganization

                                                                                      Executive FunctioningAn Overarching Theme

                                                                                      Sensory Processing Disorder Central Auditory Processing

                                                                                      Disorder ADHD and Executive Dysfunction

                                                                                      The Executive Functions

                                                                                      Internalizing speech Previewing

                                                                                      Prioritizing Tempo control Inhibition

                                                                                      The Executive Functions

                                                                                      Determining salience (whatrsquos in it for me)

                                                                                      Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                      Appropriate expectations

                                                                                      Age-appropriate expectations

                                                                                      Preschool 1-step errands Chores with cues Basic inhibition

                                                                                      Age-appropriate expectations

                                                                                      K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                      3rd ndash 5th

                                                                                      Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                      Age-appropriate expectations

                                                                                      6th ndash 8th

                                                                                      complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                      Age-appropriate expectations

                                                                                      Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                      already made Take othersrsquo perspective

                                                                                      Age-appropriate expectations

                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                      Inter-connectedness of systems Cortico-striatal system for example

                                                                                      Strategies

                                                                                      Pharmacotherapy

                                                                                      X

                                                                                      Behavioral Supports

                                                                                      A B C

                                                                                      A B C

                                                                                      behavior

                                                                                      A B C

                                                                                      consequences

                                                                                      A B C

                                                                                      antecedent

                                                                                      A B C

                                                                                      A B C

                                                                                      antecedent

                                                                                      A B C

                                                                                      antecedent

                                                                                      easy hard

                                                                                      A B C

                                                                                      consequences

                                                                                      R P

                                                                                      +

                                                                                      -

                                                                                      R+ P+

                                                                                      R- P-

                                                                                      Time Out

                                                                                      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                      Token economy

                                                                                      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                      Intrinsic motivation

                                                                                      A B C

                                                                                      consequencesX

                                                                                      A B C

                                                                                      behavior

                                                                                      Metacognition

                                                                                      Metacognitive knowledge Metacognitive strategies

                                                                                      ldquoLend Me Your Brainrdquo

                                                                                      What Does Dopamine Feel Like

                                                                                      The Physiology of Motivation and Reward

                                                                                      Preferred States What Does Dopamine Feel Like

                                                                                      1 Great experience2 Kodak moment3 The feeeeling

                                                                                      David D Nowell PhD189 May Street

                                                                                      Worcester Mass 01602DrNowellcom

                                                                                      PREFERRED STATES INVENTORY

                                                                                      wwwLulucom

                                                                                      Identify 20 peak experiences For each peak experience identify the

                                                                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                      of that moment Name it Check the 20 peak moment-feelings for

                                                                                      clusters groupings There will probably be 4 or 5

                                                                                      PREFERRED STATES INVENTORY

                                                                                      Find a word a label for each of the groupings

                                                                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                      ldquovaluesrdquo ways that you really like to feel

                                                                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                      PREFERRED STATES INVENTORY

                                                                                      PREFERRED STATES INVENTORY

                                                                                      Broaden and Build

                                                                                      ldquoNeuroMalleabilityrdquo

                                                                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                      The reward-and-planning system

                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                      The reward-and-planning system

                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                      Lend Me Your Brain

                                                                                      Supporting Clients with Executive Dysfunction

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                      Too busy with current activity

                                                                                      Field dependent

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Sequence problem-solve

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Block out distractions

                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                      - E Goldberg

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Get the reward

                                                                                      Ways the reward-and-planning system can go wrong

                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                      Instant gratification vs

                                                                                      executive gratification

                                                                                      A B C

                                                                                      behaviorx

                                                                                      Self-Talk Proficiency

                                                                                      Self-Talk Proficiency

                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                      takerdquordquo

                                                                                      Self-Talk Proficiency

                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                      Self-Talk Proficiency

                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                      thathelliprdquo

                                                                                      Match the Picture

                                                                                      Distraction Delay Training

                                                                                      Executive Estimates Training

                                                                                      X

                                                                                      Learning Time

                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                      Learning Time

                                                                                      Learning Time

                                                                                      Learning Time

                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                      Asking two questionshellip

                                                                                      Am I having fun now And is this what I set out to do

                                                                                      Am I having fun nowIs

                                                                                      this

                                                                                      what

                                                                                      I se

                                                                                      t out

                                                                                      to

                                                                                      do

                                                                                      bullYesbullYes

                                                                                      bullNobullYes

                                                                                      bullYesbullNo

                                                                                      bullNobullNo

                                                                                      Am I having fun nowIs

                                                                                      this

                                                                                      what

                                                                                      I se

                                                                                      t out

                                                                                      to

                                                                                      do

                                                                                      bullFunbullOn-task

                                                                                      bullNot funbullOn-task

                                                                                      bullFunbullNot on-task

                                                                                      bullNot funbullNot on-task

                                                                                      Key Features of Video Games

                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                      inappropriate behavior ndash never reverse this

                                                                                      Key Features of Video Games

                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                      Volkow et al 2004

                                                                                      Increase salience

                                                                                      Increase salience

                                                                                      Quarterly QI review

                                                                                      The post-mortem

                                                                                      Your 1 Organizational Tool

                                                                                      Your 1 Organizational Tool

                                                                                      Yoga read

                                                                                      Staff meeting

                                                                                      Planningsession

                                                                                      Phone calls

                                                                                      billing

                                                                                      Your 1 Organizational Tool

                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                      Your 1 Organizational Tool

                                                                                      Learn French

                                                                                      Stop smoking

                                                                                      Be a better spouse

                                                                                      The ldquoBig Fiverdquo

                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                      The ldquoBig Fiverdquo

                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                      The ldquoBig Fiverdquo

                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                      The ldquoBig Fiverdquo

                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                      The ldquoBig Fiverdquo

                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                      A CHALLENGEhellip

                                                                                      wwwDrNowellcom

                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                      DavidNowellSeminars

                                                                                      DavidNowell

                                                                                      • Slide 1
                                                                                      • hellipa challenge
                                                                                      • Slide 3
                                                                                      • Perspective of this workshophellip
                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                      • Slide 7
                                                                                      • Whatrsquos the kidrsquos deal
                                                                                      • Overview
                                                                                      • This Dense Pudding
                                                                                      • Sensory Processing Disorder
                                                                                      • Slide 12
                                                                                      • Slide 13
                                                                                      • Developmental considerations
                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                      • Slide 17
                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                      • Slide 19
                                                                                      • Strategies
                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                      • Slide 22
                                                                                      • Slide 23
                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                      • Slide 25
                                                                                      • Central Auditory Processing Disorder
                                                                                      • Slide 27
                                                                                      • Slide 28
                                                                                      • Slide 29
                                                                                      • Central Auditory Processing Disorder (2)
                                                                                      • Central Auditory Processing Disorder (3)
                                                                                      • Central Auditory Processing Disorder (4)
                                                                                      • CAPD or ADHD
                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                      • Slide 35
                                                                                      • Strategies (2)
                                                                                      • (C)APD
                                                                                      • Treatment for CAPD
                                                                                      • Treatment for CAPD (2)
                                                                                      • Self-assessment
                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                      • Slide 42
                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                      • (85 ndash X) x 365
                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                      • Core symptoms
                                                                                      • Core symptoms (2)
                                                                                      • hellipand the rest of the criteria
                                                                                      • Slide 49
                                                                                      • Functional impact of core symptoms
                                                                                      • Functional impact of core symptoms (2)
                                                                                      • Functional impact of core symptoms (3)
                                                                                      • Slide 53
                                                                                      • Functional impact of core symptoms (4)
                                                                                      • Functional impact of core symptoms (5)
                                                                                      • Functional impact of core symptoms (6)
                                                                                      • Functional impact of core symptoms (7)
                                                                                      • Functional impact of core symptoms (8)
                                                                                      • Functional impact of core symptoms (9)
                                                                                      • Subtypes of ADHD
                                                                                      • Subtypes of ADHD (2)
                                                                                      • Common comorbidities with ADHD
                                                                                      • Slide 63
                                                                                      • Common comorbidities with ADHD (2)
                                                                                      • ADHD and girls
                                                                                      • Slide 66
                                                                                      • Slide 67
                                                                                      • ADHD and women
                                                                                      • Slide 69
                                                                                      • ADHD and women (2)
                                                                                      • Executive Functioning An Overarching Theme
                                                                                      • The Executive Functions
                                                                                      • The Executive Functions (2)
                                                                                      • Slide 74
                                                                                      • Slide 75
                                                                                      • Appropriate expectations
                                                                                      • Age-appropriate expectations
                                                                                      • Age-appropriate expectations (2)
                                                                                      • Age-appropriate expectations (3)
                                                                                      • Age-appropriate expectations (4)
                                                                                      • Age-appropriate expectations (5)
                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                      • Slide 84
                                                                                      • Slide 85
                                                                                      • Strategies (3)
                                                                                      • Pharmacotherapy
                                                                                      • Behavioral Supports
                                                                                      • Slide 89
                                                                                      • Slide 90
                                                                                      • Slide 91
                                                                                      • Slide 92
                                                                                      • Slide 93
                                                                                      • Slide 94
                                                                                      • Slide 95
                                                                                      • Slide 96
                                                                                      • Slide 97
                                                                                      • Slide 98
                                                                                      • Slide 99
                                                                                      • Slide 100
                                                                                      • Slide 101
                                                                                      • Slide 102
                                                                                      • Slide 103
                                                                                      • Slide 104
                                                                                      • Slide 105
                                                                                      • Slide 106
                                                                                      • Slide 107
                                                                                      • Slide 108
                                                                                      • Slide 109
                                                                                      • Slide 110
                                                                                      • Time Out
                                                                                      • Token economy
                                                                                      • Slide 113
                                                                                      • Slide 114
                                                                                      • Slide 115
                                                                                      • Intrinsic motivation
                                                                                      • Slide 117
                                                                                      • Slide 118
                                                                                      • Slide 119
                                                                                      • Metacognition
                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                      • What Does Dopamine Feel Like
                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                      • Slide 124
                                                                                      • PREFERRED STATES INVENTORY
                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                      • Slide 128
                                                                                      • Slide 129
                                                                                      • Broaden and Build
                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                      • The reward-and-planning system
                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                      • The reward-and-planning system (2)
                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                      • Slide 141
                                                                                      • Lend Me Your Brain
                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                      • Slide 146
                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                      • Slide 149
                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                      • Slide 152
                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                      • Slide 154
                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                      • Slide 157
                                                                                      • Slide 158
                                                                                      • Slide 159
                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                      • Slide 162
                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                      • Slide 164
                                                                                      • Instant gratification vs executive gratification
                                                                                      • Slide 166
                                                                                      • Slide 167
                                                                                      • Slide 168
                                                                                      • Slide 169
                                                                                      • Slide 170
                                                                                      • Self-Talk Proficiency
                                                                                      • Self-Talk Proficiency (2)
                                                                                      • Self-Talk Proficiency (3)
                                                                                      • Self-Talk Proficiency (4)
                                                                                      • Match the Picture
                                                                                      • Slide 176
                                                                                      • Slide 177
                                                                                      • Distraction Delay Training
                                                                                      • Slide 179
                                                                                      • Slide 180
                                                                                      • Executive Estimates Training
                                                                                      • Learning Time
                                                                                      • Learning Time (2)
                                                                                      • Learning Time (3)
                                                                                      • Slide 185
                                                                                      • Slide 186
                                                                                      • Learning Time (4)
                                                                                      • Asking two questionshellip
                                                                                      • Slide 189
                                                                                      • Slide 190
                                                                                      • Key Features of Video Games
                                                                                      • Key Features of Video Games (2)
                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                      • Slide 194
                                                                                      • Slide 195
                                                                                      • Slide 196
                                                                                      • Slide 197
                                                                                      • Slide 198
                                                                                      • Slide 199
                                                                                      • Slide 200
                                                                                      • Slide 201
                                                                                      • Quarterly QI review
                                                                                      • The post-mortem
                                                                                      • Slide 204
                                                                                      • Slide 205
                                                                                      • Slide 206
                                                                                      • Slide 207
                                                                                      • Slide 208
                                                                                      • Slide 209
                                                                                      • Slide 210
                                                                                      • The ldquoBig Fiverdquo
                                                                                      • Slide 212
                                                                                      • Slide 213
                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                      • Slide 215
                                                                                      • Slide 216
                                                                                      • Slide 217
                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                      • A challengehellip
                                                                                      • Slide 222

                                                                                        Functional impact of core symptoms

                                                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                        Functional impact of core symptoms

                                                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                        Functional impact of core symptoms

                                                                                        Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                        Subtypes of ADHD

                                                                                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                                        Subtypes of ADHD

                                                                                        ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                                        Specifed

                                                                                        Common comorbidities with ADHD

                                                                                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                        processing challenges

                                                                                        Common comorbidities with ADHD

                                                                                        Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                        processing challenges

                                                                                        ADHD and girls

                                                                                        ADHD and women

                                                                                        ADHD and women

                                                                                        More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                        partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                        disorganization

                                                                                        Executive FunctioningAn Overarching Theme

                                                                                        Sensory Processing Disorder Central Auditory Processing

                                                                                        Disorder ADHD and Executive Dysfunction

                                                                                        The Executive Functions

                                                                                        Internalizing speech Previewing

                                                                                        Prioritizing Tempo control Inhibition

                                                                                        The Executive Functions

                                                                                        Determining salience (whatrsquos in it for me)

                                                                                        Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                        Appropriate expectations

                                                                                        Age-appropriate expectations

                                                                                        Preschool 1-step errands Chores with cues Basic inhibition

                                                                                        Age-appropriate expectations

                                                                                        K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                        3rd ndash 5th

                                                                                        Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                        Age-appropriate expectations

                                                                                        6th ndash 8th

                                                                                        complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                        Age-appropriate expectations

                                                                                        Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                        already made Take othersrsquo perspective

                                                                                        Age-appropriate expectations

                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                        Inter-connectedness of systems Cortico-striatal system for example

                                                                                        Strategies

                                                                                        Pharmacotherapy

                                                                                        X

                                                                                        Behavioral Supports

                                                                                        A B C

                                                                                        A B C

                                                                                        behavior

                                                                                        A B C

                                                                                        consequences

                                                                                        A B C

                                                                                        antecedent

                                                                                        A B C

                                                                                        A B C

                                                                                        antecedent

                                                                                        A B C

                                                                                        antecedent

                                                                                        easy hard

                                                                                        A B C

                                                                                        consequences

                                                                                        R P

                                                                                        +

                                                                                        -

                                                                                        R+ P+

                                                                                        R- P-

                                                                                        Time Out

                                                                                        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                        Token economy

                                                                                        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                        Intrinsic motivation

                                                                                        A B C

                                                                                        consequencesX

                                                                                        A B C

                                                                                        behavior

                                                                                        Metacognition

                                                                                        Metacognitive knowledge Metacognitive strategies

                                                                                        ldquoLend Me Your Brainrdquo

                                                                                        What Does Dopamine Feel Like

                                                                                        The Physiology of Motivation and Reward

                                                                                        Preferred States What Does Dopamine Feel Like

                                                                                        1 Great experience2 Kodak moment3 The feeeeling

                                                                                        David D Nowell PhD189 May Street

                                                                                        Worcester Mass 01602DrNowellcom

                                                                                        PREFERRED STATES INVENTORY

                                                                                        wwwLulucom

                                                                                        Identify 20 peak experiences For each peak experience identify the

                                                                                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                        of that moment Name it Check the 20 peak moment-feelings for

                                                                                        clusters groupings There will probably be 4 or 5

                                                                                        PREFERRED STATES INVENTORY

                                                                                        Find a word a label for each of the groupings

                                                                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                        ldquovaluesrdquo ways that you really like to feel

                                                                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                        PREFERRED STATES INVENTORY

                                                                                        PREFERRED STATES INVENTORY

                                                                                        Broaden and Build

                                                                                        ldquoNeuroMalleabilityrdquo

                                                                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                        The reward-and-planning system

                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                        The reward-and-planning system

                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                        Lend Me Your Brain

                                                                                        Supporting Clients with Executive Dysfunction

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                        Too busy with current activity

                                                                                        Field dependent

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Sequence problem-solve

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Block out distractions

                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                        - E Goldberg

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Get the reward

                                                                                        Ways the reward-and-planning system can go wrong

                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                        Instant gratification vs

                                                                                        executive gratification

                                                                                        A B C

                                                                                        behaviorx

                                                                                        Self-Talk Proficiency

                                                                                        Self-Talk Proficiency

                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                        takerdquordquo

                                                                                        Self-Talk Proficiency

                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                        Self-Talk Proficiency

                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                        thathelliprdquo

                                                                                        Match the Picture

                                                                                        Distraction Delay Training

                                                                                        Executive Estimates Training

                                                                                        X

                                                                                        Learning Time

                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                        Learning Time

                                                                                        Learning Time

                                                                                        Learning Time

                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                        Asking two questionshellip

                                                                                        Am I having fun now And is this what I set out to do

                                                                                        Am I having fun nowIs

                                                                                        this

                                                                                        what

                                                                                        I se

                                                                                        t out

                                                                                        to

                                                                                        do

                                                                                        bullYesbullYes

                                                                                        bullNobullYes

                                                                                        bullYesbullNo

                                                                                        bullNobullNo

                                                                                        Am I having fun nowIs

                                                                                        this

                                                                                        what

                                                                                        I se

                                                                                        t out

                                                                                        to

                                                                                        do

                                                                                        bullFunbullOn-task

                                                                                        bullNot funbullOn-task

                                                                                        bullFunbullNot on-task

                                                                                        bullNot funbullNot on-task

                                                                                        Key Features of Video Games

                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                        inappropriate behavior ndash never reverse this

                                                                                        Key Features of Video Games

                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                        Volkow et al 2004

                                                                                        Increase salience

                                                                                        Increase salience

                                                                                        Quarterly QI review

                                                                                        The post-mortem

                                                                                        Your 1 Organizational Tool

                                                                                        Your 1 Organizational Tool

                                                                                        Yoga read

                                                                                        Staff meeting

                                                                                        Planningsession

                                                                                        Phone calls

                                                                                        billing

                                                                                        Your 1 Organizational Tool

                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                        Your 1 Organizational Tool

                                                                                        Learn French

                                                                                        Stop smoking

                                                                                        Be a better spouse

                                                                                        The ldquoBig Fiverdquo

                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                        The ldquoBig Fiverdquo

                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                        The ldquoBig Fiverdquo

                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                        The ldquoBig Fiverdquo

                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                        The ldquoBig Fiverdquo

                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                        A CHALLENGEhellip

                                                                                        wwwDrNowellcom

                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                        DavidNowellSeminars

                                                                                        DavidNowell

                                                                                        • Slide 1
                                                                                        • hellipa challenge
                                                                                        • Slide 3
                                                                                        • Perspective of this workshophellip
                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                        • Slide 7
                                                                                        • Whatrsquos the kidrsquos deal
                                                                                        • Overview
                                                                                        • This Dense Pudding
                                                                                        • Sensory Processing Disorder
                                                                                        • Slide 12
                                                                                        • Slide 13
                                                                                        • Developmental considerations
                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                        • Slide 17
                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                        • Slide 19
                                                                                        • Strategies
                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                        • Slide 22
                                                                                        • Slide 23
                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                        • Slide 25
                                                                                        • Central Auditory Processing Disorder
                                                                                        • Slide 27
                                                                                        • Slide 28
                                                                                        • Slide 29
                                                                                        • Central Auditory Processing Disorder (2)
                                                                                        • Central Auditory Processing Disorder (3)
                                                                                        • Central Auditory Processing Disorder (4)
                                                                                        • CAPD or ADHD
                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                        • Slide 35
                                                                                        • Strategies (2)
                                                                                        • (C)APD
                                                                                        • Treatment for CAPD
                                                                                        • Treatment for CAPD (2)
                                                                                        • Self-assessment
                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                        • Slide 42
                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                        • (85 ndash X) x 365
                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                        • Core symptoms
                                                                                        • Core symptoms (2)
                                                                                        • hellipand the rest of the criteria
                                                                                        • Slide 49
                                                                                        • Functional impact of core symptoms
                                                                                        • Functional impact of core symptoms (2)
                                                                                        • Functional impact of core symptoms (3)
                                                                                        • Slide 53
                                                                                        • Functional impact of core symptoms (4)
                                                                                        • Functional impact of core symptoms (5)
                                                                                        • Functional impact of core symptoms (6)
                                                                                        • Functional impact of core symptoms (7)
                                                                                        • Functional impact of core symptoms (8)
                                                                                        • Functional impact of core symptoms (9)
                                                                                        • Subtypes of ADHD
                                                                                        • Subtypes of ADHD (2)
                                                                                        • Common comorbidities with ADHD
                                                                                        • Slide 63
                                                                                        • Common comorbidities with ADHD (2)
                                                                                        • ADHD and girls
                                                                                        • Slide 66
                                                                                        • Slide 67
                                                                                        • ADHD and women
                                                                                        • Slide 69
                                                                                        • ADHD and women (2)
                                                                                        • Executive Functioning An Overarching Theme
                                                                                        • The Executive Functions
                                                                                        • The Executive Functions (2)
                                                                                        • Slide 74
                                                                                        • Slide 75
                                                                                        • Appropriate expectations
                                                                                        • Age-appropriate expectations
                                                                                        • Age-appropriate expectations (2)
                                                                                        • Age-appropriate expectations (3)
                                                                                        • Age-appropriate expectations (4)
                                                                                        • Age-appropriate expectations (5)
                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                        • Slide 84
                                                                                        • Slide 85
                                                                                        • Strategies (3)
                                                                                        • Pharmacotherapy
                                                                                        • Behavioral Supports
                                                                                        • Slide 89
                                                                                        • Slide 90
                                                                                        • Slide 91
                                                                                        • Slide 92
                                                                                        • Slide 93
                                                                                        • Slide 94
                                                                                        • Slide 95
                                                                                        • Slide 96
                                                                                        • Slide 97
                                                                                        • Slide 98
                                                                                        • Slide 99
                                                                                        • Slide 100
                                                                                        • Slide 101
                                                                                        • Slide 102
                                                                                        • Slide 103
                                                                                        • Slide 104
                                                                                        • Slide 105
                                                                                        • Slide 106
                                                                                        • Slide 107
                                                                                        • Slide 108
                                                                                        • Slide 109
                                                                                        • Slide 110
                                                                                        • Time Out
                                                                                        • Token economy
                                                                                        • Slide 113
                                                                                        • Slide 114
                                                                                        • Slide 115
                                                                                        • Intrinsic motivation
                                                                                        • Slide 117
                                                                                        • Slide 118
                                                                                        • Slide 119
                                                                                        • Metacognition
                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                        • What Does Dopamine Feel Like
                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                        • Slide 124
                                                                                        • PREFERRED STATES INVENTORY
                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                        • Slide 128
                                                                                        • Slide 129
                                                                                        • Broaden and Build
                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                        • The reward-and-planning system
                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                        • The reward-and-planning system (2)
                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                        • Slide 141
                                                                                        • Lend Me Your Brain
                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                        • Slide 146
                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                        • Slide 149
                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                        • Slide 152
                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                        • Slide 154
                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                        • Slide 157
                                                                                        • Slide 158
                                                                                        • Slide 159
                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                        • Slide 162
                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                        • Slide 164
                                                                                        • Instant gratification vs executive gratification
                                                                                        • Slide 166
                                                                                        • Slide 167
                                                                                        • Slide 168
                                                                                        • Slide 169
                                                                                        • Slide 170
                                                                                        • Self-Talk Proficiency
                                                                                        • Self-Talk Proficiency (2)
                                                                                        • Self-Talk Proficiency (3)
                                                                                        • Self-Talk Proficiency (4)
                                                                                        • Match the Picture
                                                                                        • Slide 176
                                                                                        • Slide 177
                                                                                        • Distraction Delay Training
                                                                                        • Slide 179
                                                                                        • Slide 180
                                                                                        • Executive Estimates Training
                                                                                        • Learning Time
                                                                                        • Learning Time (2)
                                                                                        • Learning Time (3)
                                                                                        • Slide 185
                                                                                        • Slide 186
                                                                                        • Learning Time (4)
                                                                                        • Asking two questionshellip
                                                                                        • Slide 189
                                                                                        • Slide 190
                                                                                        • Key Features of Video Games
                                                                                        • Key Features of Video Games (2)
                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                        • Slide 194
                                                                                        • Slide 195
                                                                                        • Slide 196
                                                                                        • Slide 197
                                                                                        • Slide 198
                                                                                        • Slide 199
                                                                                        • Slide 200
                                                                                        • Slide 201
                                                                                        • Quarterly QI review
                                                                                        • The post-mortem
                                                                                        • Slide 204
                                                                                        • Slide 205
                                                                                        • Slide 206
                                                                                        • Slide 207
                                                                                        • Slide 208
                                                                                        • Slide 209
                                                                                        • Slide 210
                                                                                        • The ldquoBig Fiverdquo
                                                                                        • Slide 212
                                                                                        • Slide 213
                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                        • Slide 215
                                                                                        • Slide 216
                                                                                        • Slide 217
                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                        • A challengehellip
                                                                                        • Slide 222

                                                                                          Functional impact of core symptoms

                                                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                          Functional impact of core symptoms

                                                                                          Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                          Subtypes of ADHD

                                                                                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                                          Subtypes of ADHD

                                                                                          ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                                          Specifed

                                                                                          Common comorbidities with ADHD

                                                                                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                          processing challenges

                                                                                          Common comorbidities with ADHD

                                                                                          Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                          processing challenges

                                                                                          ADHD and girls

                                                                                          ADHD and women

                                                                                          ADHD and women

                                                                                          More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                          partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                          disorganization

                                                                                          Executive FunctioningAn Overarching Theme

                                                                                          Sensory Processing Disorder Central Auditory Processing

                                                                                          Disorder ADHD and Executive Dysfunction

                                                                                          The Executive Functions

                                                                                          Internalizing speech Previewing

                                                                                          Prioritizing Tempo control Inhibition

                                                                                          The Executive Functions

                                                                                          Determining salience (whatrsquos in it for me)

                                                                                          Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                          Appropriate expectations

                                                                                          Age-appropriate expectations

                                                                                          Preschool 1-step errands Chores with cues Basic inhibition

                                                                                          Age-appropriate expectations

                                                                                          K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                          3rd ndash 5th

                                                                                          Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                          Age-appropriate expectations

                                                                                          6th ndash 8th

                                                                                          complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                          Age-appropriate expectations

                                                                                          Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                          already made Take othersrsquo perspective

                                                                                          Age-appropriate expectations

                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                          Inter-connectedness of systems Cortico-striatal system for example

                                                                                          Strategies

                                                                                          Pharmacotherapy

                                                                                          X

                                                                                          Behavioral Supports

                                                                                          A B C

                                                                                          A B C

                                                                                          behavior

                                                                                          A B C

                                                                                          consequences

                                                                                          A B C

                                                                                          antecedent

                                                                                          A B C

                                                                                          A B C

                                                                                          antecedent

                                                                                          A B C

                                                                                          antecedent

                                                                                          easy hard

                                                                                          A B C

                                                                                          consequences

                                                                                          R P

                                                                                          +

                                                                                          -

                                                                                          R+ P+

                                                                                          R- P-

                                                                                          Time Out

                                                                                          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                          Token economy

                                                                                          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                          Intrinsic motivation

                                                                                          A B C

                                                                                          consequencesX

                                                                                          A B C

                                                                                          behavior

                                                                                          Metacognition

                                                                                          Metacognitive knowledge Metacognitive strategies

                                                                                          ldquoLend Me Your Brainrdquo

                                                                                          What Does Dopamine Feel Like

                                                                                          The Physiology of Motivation and Reward

                                                                                          Preferred States What Does Dopamine Feel Like

                                                                                          1 Great experience2 Kodak moment3 The feeeeling

                                                                                          David D Nowell PhD189 May Street

                                                                                          Worcester Mass 01602DrNowellcom

                                                                                          PREFERRED STATES INVENTORY

                                                                                          wwwLulucom

                                                                                          Identify 20 peak experiences For each peak experience identify the

                                                                                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                          of that moment Name it Check the 20 peak moment-feelings for

                                                                                          clusters groupings There will probably be 4 or 5

                                                                                          PREFERRED STATES INVENTORY

                                                                                          Find a word a label for each of the groupings

                                                                                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                          ldquovaluesrdquo ways that you really like to feel

                                                                                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                          PREFERRED STATES INVENTORY

                                                                                          PREFERRED STATES INVENTORY

                                                                                          Broaden and Build

                                                                                          ldquoNeuroMalleabilityrdquo

                                                                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                          The reward-and-planning system

                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                          The reward-and-planning system

                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                          Lend Me Your Brain

                                                                                          Supporting Clients with Executive Dysfunction

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                          Too busy with current activity

                                                                                          Field dependent

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Sequence problem-solve

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Block out distractions

                                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                          - E Goldberg

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Get the reward

                                                                                          Ways the reward-and-planning system can go wrong

                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                          Instant gratification vs

                                                                                          executive gratification

                                                                                          A B C

                                                                                          behaviorx

                                                                                          Self-Talk Proficiency

                                                                                          Self-Talk Proficiency

                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                          takerdquordquo

                                                                                          Self-Talk Proficiency

                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                          Self-Talk Proficiency

                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                          thathelliprdquo

                                                                                          Match the Picture

                                                                                          Distraction Delay Training

                                                                                          Executive Estimates Training

                                                                                          X

                                                                                          Learning Time

                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                          Learning Time

                                                                                          Learning Time

                                                                                          Learning Time

                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                          Asking two questionshellip

                                                                                          Am I having fun now And is this what I set out to do

                                                                                          Am I having fun nowIs

                                                                                          this

                                                                                          what

                                                                                          I se

                                                                                          t out

                                                                                          to

                                                                                          do

                                                                                          bullYesbullYes

                                                                                          bullNobullYes

                                                                                          bullYesbullNo

                                                                                          bullNobullNo

                                                                                          Am I having fun nowIs

                                                                                          this

                                                                                          what

                                                                                          I se

                                                                                          t out

                                                                                          to

                                                                                          do

                                                                                          bullFunbullOn-task

                                                                                          bullNot funbullOn-task

                                                                                          bullFunbullNot on-task

                                                                                          bullNot funbullNot on-task

                                                                                          Key Features of Video Games

                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                          inappropriate behavior ndash never reverse this

                                                                                          Key Features of Video Games

                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                          Volkow et al 2004

                                                                                          Increase salience

                                                                                          Increase salience

                                                                                          Quarterly QI review

                                                                                          The post-mortem

                                                                                          Your 1 Organizational Tool

                                                                                          Your 1 Organizational Tool

                                                                                          Yoga read

                                                                                          Staff meeting

                                                                                          Planningsession

                                                                                          Phone calls

                                                                                          billing

                                                                                          Your 1 Organizational Tool

                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                          Your 1 Organizational Tool

                                                                                          Learn French

                                                                                          Stop smoking

                                                                                          Be a better spouse

                                                                                          The ldquoBig Fiverdquo

                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                          The ldquoBig Fiverdquo

                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                          The ldquoBig Fiverdquo

                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                          The ldquoBig Fiverdquo

                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                          The ldquoBig Fiverdquo

                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                          A CHALLENGEhellip

                                                                                          wwwDrNowellcom

                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                          DavidNowellSeminars

                                                                                          DavidNowell

                                                                                          • Slide 1
                                                                                          • hellipa challenge
                                                                                          • Slide 3
                                                                                          • Perspective of this workshophellip
                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                          • Slide 7
                                                                                          • Whatrsquos the kidrsquos deal
                                                                                          • Overview
                                                                                          • This Dense Pudding
                                                                                          • Sensory Processing Disorder
                                                                                          • Slide 12
                                                                                          • Slide 13
                                                                                          • Developmental considerations
                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                          • Slide 17
                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                          • Slide 19
                                                                                          • Strategies
                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                          • Slide 22
                                                                                          • Slide 23
                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                          • Slide 25
                                                                                          • Central Auditory Processing Disorder
                                                                                          • Slide 27
                                                                                          • Slide 28
                                                                                          • Slide 29
                                                                                          • Central Auditory Processing Disorder (2)
                                                                                          • Central Auditory Processing Disorder (3)
                                                                                          • Central Auditory Processing Disorder (4)
                                                                                          • CAPD or ADHD
                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                          • Slide 35
                                                                                          • Strategies (2)
                                                                                          • (C)APD
                                                                                          • Treatment for CAPD
                                                                                          • Treatment for CAPD (2)
                                                                                          • Self-assessment
                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                          • Slide 42
                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                          • (85 ndash X) x 365
                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                          • Core symptoms
                                                                                          • Core symptoms (2)
                                                                                          • hellipand the rest of the criteria
                                                                                          • Slide 49
                                                                                          • Functional impact of core symptoms
                                                                                          • Functional impact of core symptoms (2)
                                                                                          • Functional impact of core symptoms (3)
                                                                                          • Slide 53
                                                                                          • Functional impact of core symptoms (4)
                                                                                          • Functional impact of core symptoms (5)
                                                                                          • Functional impact of core symptoms (6)
                                                                                          • Functional impact of core symptoms (7)
                                                                                          • Functional impact of core symptoms (8)
                                                                                          • Functional impact of core symptoms (9)
                                                                                          • Subtypes of ADHD
                                                                                          • Subtypes of ADHD (2)
                                                                                          • Common comorbidities with ADHD
                                                                                          • Slide 63
                                                                                          • Common comorbidities with ADHD (2)
                                                                                          • ADHD and girls
                                                                                          • Slide 66
                                                                                          • Slide 67
                                                                                          • ADHD and women
                                                                                          • Slide 69
                                                                                          • ADHD and women (2)
                                                                                          • Executive Functioning An Overarching Theme
                                                                                          • The Executive Functions
                                                                                          • The Executive Functions (2)
                                                                                          • Slide 74
                                                                                          • Slide 75
                                                                                          • Appropriate expectations
                                                                                          • Age-appropriate expectations
                                                                                          • Age-appropriate expectations (2)
                                                                                          • Age-appropriate expectations (3)
                                                                                          • Age-appropriate expectations (4)
                                                                                          • Age-appropriate expectations (5)
                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                          • Slide 84
                                                                                          • Slide 85
                                                                                          • Strategies (3)
                                                                                          • Pharmacotherapy
                                                                                          • Behavioral Supports
                                                                                          • Slide 89
                                                                                          • Slide 90
                                                                                          • Slide 91
                                                                                          • Slide 92
                                                                                          • Slide 93
                                                                                          • Slide 94
                                                                                          • Slide 95
                                                                                          • Slide 96
                                                                                          • Slide 97
                                                                                          • Slide 98
                                                                                          • Slide 99
                                                                                          • Slide 100
                                                                                          • Slide 101
                                                                                          • Slide 102
                                                                                          • Slide 103
                                                                                          • Slide 104
                                                                                          • Slide 105
                                                                                          • Slide 106
                                                                                          • Slide 107
                                                                                          • Slide 108
                                                                                          • Slide 109
                                                                                          • Slide 110
                                                                                          • Time Out
                                                                                          • Token economy
                                                                                          • Slide 113
                                                                                          • Slide 114
                                                                                          • Slide 115
                                                                                          • Intrinsic motivation
                                                                                          • Slide 117
                                                                                          • Slide 118
                                                                                          • Slide 119
                                                                                          • Metacognition
                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                          • What Does Dopamine Feel Like
                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                          • Slide 124
                                                                                          • PREFERRED STATES INVENTORY
                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                          • Slide 128
                                                                                          • Slide 129
                                                                                          • Broaden and Build
                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                          • The reward-and-planning system
                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                          • The reward-and-planning system (2)
                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                          • Slide 141
                                                                                          • Lend Me Your Brain
                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                          • Slide 146
                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                          • Slide 149
                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                          • Slide 152
                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                          • Slide 154
                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                          • Slide 157
                                                                                          • Slide 158
                                                                                          • Slide 159
                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                          • Slide 162
                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                          • Slide 164
                                                                                          • Instant gratification vs executive gratification
                                                                                          • Slide 166
                                                                                          • Slide 167
                                                                                          • Slide 168
                                                                                          • Slide 169
                                                                                          • Slide 170
                                                                                          • Self-Talk Proficiency
                                                                                          • Self-Talk Proficiency (2)
                                                                                          • Self-Talk Proficiency (3)
                                                                                          • Self-Talk Proficiency (4)
                                                                                          • Match the Picture
                                                                                          • Slide 176
                                                                                          • Slide 177
                                                                                          • Distraction Delay Training
                                                                                          • Slide 179
                                                                                          • Slide 180
                                                                                          • Executive Estimates Training
                                                                                          • Learning Time
                                                                                          • Learning Time (2)
                                                                                          • Learning Time (3)
                                                                                          • Slide 185
                                                                                          • Slide 186
                                                                                          • Learning Time (4)
                                                                                          • Asking two questionshellip
                                                                                          • Slide 189
                                                                                          • Slide 190
                                                                                          • Key Features of Video Games
                                                                                          • Key Features of Video Games (2)
                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                          • Slide 194
                                                                                          • Slide 195
                                                                                          • Slide 196
                                                                                          • Slide 197
                                                                                          • Slide 198
                                                                                          • Slide 199
                                                                                          • Slide 200
                                                                                          • Slide 201
                                                                                          • Quarterly QI review
                                                                                          • The post-mortem
                                                                                          • Slide 204
                                                                                          • Slide 205
                                                                                          • Slide 206
                                                                                          • Slide 207
                                                                                          • Slide 208
                                                                                          • Slide 209
                                                                                          • Slide 210
                                                                                          • The ldquoBig Fiverdquo
                                                                                          • Slide 212
                                                                                          • Slide 213
                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                          • Slide 215
                                                                                          • Slide 216
                                                                                          • Slide 217
                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                          • A challengehellip
                                                                                          • Slide 222

                                                                                            Functional impact of core symptoms

                                                                                            Satisfaction control Previewing Inhibition Tempo control Self-monitoring and correcting

                                                                                            Subtypes of ADHD

                                                                                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                                            Subtypes of ADHD

                                                                                            ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                                            Specifed

                                                                                            Common comorbidities with ADHD

                                                                                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                            processing challenges

                                                                                            Common comorbidities with ADHD

                                                                                            Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                            processing challenges

                                                                                            ADHD and girls

                                                                                            ADHD and women

                                                                                            ADHD and women

                                                                                            More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                            partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                            disorganization

                                                                                            Executive FunctioningAn Overarching Theme

                                                                                            Sensory Processing Disorder Central Auditory Processing

                                                                                            Disorder ADHD and Executive Dysfunction

                                                                                            The Executive Functions

                                                                                            Internalizing speech Previewing

                                                                                            Prioritizing Tempo control Inhibition

                                                                                            The Executive Functions

                                                                                            Determining salience (whatrsquos in it for me)

                                                                                            Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                            Appropriate expectations

                                                                                            Age-appropriate expectations

                                                                                            Preschool 1-step errands Chores with cues Basic inhibition

                                                                                            Age-appropriate expectations

                                                                                            K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                            3rd ndash 5th

                                                                                            Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                            Age-appropriate expectations

                                                                                            6th ndash 8th

                                                                                            complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                            Age-appropriate expectations

                                                                                            Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                            already made Take othersrsquo perspective

                                                                                            Age-appropriate expectations

                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                            Inter-connectedness of systems Cortico-striatal system for example

                                                                                            Strategies

                                                                                            Pharmacotherapy

                                                                                            X

                                                                                            Behavioral Supports

                                                                                            A B C

                                                                                            A B C

                                                                                            behavior

                                                                                            A B C

                                                                                            consequences

                                                                                            A B C

                                                                                            antecedent

                                                                                            A B C

                                                                                            A B C

                                                                                            antecedent

                                                                                            A B C

                                                                                            antecedent

                                                                                            easy hard

                                                                                            A B C

                                                                                            consequences

                                                                                            R P

                                                                                            +

                                                                                            -

                                                                                            R+ P+

                                                                                            R- P-

                                                                                            Time Out

                                                                                            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                            Token economy

                                                                                            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                            Intrinsic motivation

                                                                                            A B C

                                                                                            consequencesX

                                                                                            A B C

                                                                                            behavior

                                                                                            Metacognition

                                                                                            Metacognitive knowledge Metacognitive strategies

                                                                                            ldquoLend Me Your Brainrdquo

                                                                                            What Does Dopamine Feel Like

                                                                                            The Physiology of Motivation and Reward

                                                                                            Preferred States What Does Dopamine Feel Like

                                                                                            1 Great experience2 Kodak moment3 The feeeeling

                                                                                            David D Nowell PhD189 May Street

                                                                                            Worcester Mass 01602DrNowellcom

                                                                                            PREFERRED STATES INVENTORY

                                                                                            wwwLulucom

                                                                                            Identify 20 peak experiences For each peak experience identify the

                                                                                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                            of that moment Name it Check the 20 peak moment-feelings for

                                                                                            clusters groupings There will probably be 4 or 5

                                                                                            PREFERRED STATES INVENTORY

                                                                                            Find a word a label for each of the groupings

                                                                                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                            ldquovaluesrdquo ways that you really like to feel

                                                                                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                            PREFERRED STATES INVENTORY

                                                                                            PREFERRED STATES INVENTORY

                                                                                            Broaden and Build

                                                                                            ldquoNeuroMalleabilityrdquo

                                                                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                            The reward-and-planning system

                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                            The reward-and-planning system

                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                            Lend Me Your Brain

                                                                                            Supporting Clients with Executive Dysfunction

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                            Too busy with current activity

                                                                                            Field dependent

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Sequence problem-solve

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Block out distractions

                                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                            - E Goldberg

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Get the reward

                                                                                            Ways the reward-and-planning system can go wrong

                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                            Instant gratification vs

                                                                                            executive gratification

                                                                                            A B C

                                                                                            behaviorx

                                                                                            Self-Talk Proficiency

                                                                                            Self-Talk Proficiency

                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                            takerdquordquo

                                                                                            Self-Talk Proficiency

                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                            Self-Talk Proficiency

                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                            thathelliprdquo

                                                                                            Match the Picture

                                                                                            Distraction Delay Training

                                                                                            Executive Estimates Training

                                                                                            X

                                                                                            Learning Time

                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                            Learning Time

                                                                                            Learning Time

                                                                                            Learning Time

                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                            Asking two questionshellip

                                                                                            Am I having fun now And is this what I set out to do

                                                                                            Am I having fun nowIs

                                                                                            this

                                                                                            what

                                                                                            I se

                                                                                            t out

                                                                                            to

                                                                                            do

                                                                                            bullYesbullYes

                                                                                            bullNobullYes

                                                                                            bullYesbullNo

                                                                                            bullNobullNo

                                                                                            Am I having fun nowIs

                                                                                            this

                                                                                            what

                                                                                            I se

                                                                                            t out

                                                                                            to

                                                                                            do

                                                                                            bullFunbullOn-task

                                                                                            bullNot funbullOn-task

                                                                                            bullFunbullNot on-task

                                                                                            bullNot funbullNot on-task

                                                                                            Key Features of Video Games

                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                            inappropriate behavior ndash never reverse this

                                                                                            Key Features of Video Games

                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                            Volkow et al 2004

                                                                                            Increase salience

                                                                                            Increase salience

                                                                                            Quarterly QI review

                                                                                            The post-mortem

                                                                                            Your 1 Organizational Tool

                                                                                            Your 1 Organizational Tool

                                                                                            Yoga read

                                                                                            Staff meeting

                                                                                            Planningsession

                                                                                            Phone calls

                                                                                            billing

                                                                                            Your 1 Organizational Tool

                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                            Your 1 Organizational Tool

                                                                                            Learn French

                                                                                            Stop smoking

                                                                                            Be a better spouse

                                                                                            The ldquoBig Fiverdquo

                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                            The ldquoBig Fiverdquo

                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                            The ldquoBig Fiverdquo

                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                            The ldquoBig Fiverdquo

                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                            The ldquoBig Fiverdquo

                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                            A CHALLENGEhellip

                                                                                            wwwDrNowellcom

                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                            DavidNowellSeminars

                                                                                            DavidNowell

                                                                                            • Slide 1
                                                                                            • hellipa challenge
                                                                                            • Slide 3
                                                                                            • Perspective of this workshophellip
                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                            • Slide 7
                                                                                            • Whatrsquos the kidrsquos deal
                                                                                            • Overview
                                                                                            • This Dense Pudding
                                                                                            • Sensory Processing Disorder
                                                                                            • Slide 12
                                                                                            • Slide 13
                                                                                            • Developmental considerations
                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                            • Slide 17
                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                            • Slide 19
                                                                                            • Strategies
                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                            • Slide 22
                                                                                            • Slide 23
                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                            • Slide 25
                                                                                            • Central Auditory Processing Disorder
                                                                                            • Slide 27
                                                                                            • Slide 28
                                                                                            • Slide 29
                                                                                            • Central Auditory Processing Disorder (2)
                                                                                            • Central Auditory Processing Disorder (3)
                                                                                            • Central Auditory Processing Disorder (4)
                                                                                            • CAPD or ADHD
                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                            • Slide 35
                                                                                            • Strategies (2)
                                                                                            • (C)APD
                                                                                            • Treatment for CAPD
                                                                                            • Treatment for CAPD (2)
                                                                                            • Self-assessment
                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                            • Slide 42
                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                            • (85 ndash X) x 365
                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                            • Core symptoms
                                                                                            • Core symptoms (2)
                                                                                            • hellipand the rest of the criteria
                                                                                            • Slide 49
                                                                                            • Functional impact of core symptoms
                                                                                            • Functional impact of core symptoms (2)
                                                                                            • Functional impact of core symptoms (3)
                                                                                            • Slide 53
                                                                                            • Functional impact of core symptoms (4)
                                                                                            • Functional impact of core symptoms (5)
                                                                                            • Functional impact of core symptoms (6)
                                                                                            • Functional impact of core symptoms (7)
                                                                                            • Functional impact of core symptoms (8)
                                                                                            • Functional impact of core symptoms (9)
                                                                                            • Subtypes of ADHD
                                                                                            • Subtypes of ADHD (2)
                                                                                            • Common comorbidities with ADHD
                                                                                            • Slide 63
                                                                                            • Common comorbidities with ADHD (2)
                                                                                            • ADHD and girls
                                                                                            • Slide 66
                                                                                            • Slide 67
                                                                                            • ADHD and women
                                                                                            • Slide 69
                                                                                            • ADHD and women (2)
                                                                                            • Executive Functioning An Overarching Theme
                                                                                            • The Executive Functions
                                                                                            • The Executive Functions (2)
                                                                                            • Slide 74
                                                                                            • Slide 75
                                                                                            • Appropriate expectations
                                                                                            • Age-appropriate expectations
                                                                                            • Age-appropriate expectations (2)
                                                                                            • Age-appropriate expectations (3)
                                                                                            • Age-appropriate expectations (4)
                                                                                            • Age-appropriate expectations (5)
                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                            • Slide 84
                                                                                            • Slide 85
                                                                                            • Strategies (3)
                                                                                            • Pharmacotherapy
                                                                                            • Behavioral Supports
                                                                                            • Slide 89
                                                                                            • Slide 90
                                                                                            • Slide 91
                                                                                            • Slide 92
                                                                                            • Slide 93
                                                                                            • Slide 94
                                                                                            • Slide 95
                                                                                            • Slide 96
                                                                                            • Slide 97
                                                                                            • Slide 98
                                                                                            • Slide 99
                                                                                            • Slide 100
                                                                                            • Slide 101
                                                                                            • Slide 102
                                                                                            • Slide 103
                                                                                            • Slide 104
                                                                                            • Slide 105
                                                                                            • Slide 106
                                                                                            • Slide 107
                                                                                            • Slide 108
                                                                                            • Slide 109
                                                                                            • Slide 110
                                                                                            • Time Out
                                                                                            • Token economy
                                                                                            • Slide 113
                                                                                            • Slide 114
                                                                                            • Slide 115
                                                                                            • Intrinsic motivation
                                                                                            • Slide 117
                                                                                            • Slide 118
                                                                                            • Slide 119
                                                                                            • Metacognition
                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                            • What Does Dopamine Feel Like
                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                            • Slide 124
                                                                                            • PREFERRED STATES INVENTORY
                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                            • Slide 128
                                                                                            • Slide 129
                                                                                            • Broaden and Build
                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                            • The reward-and-planning system
                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                            • The reward-and-planning system (2)
                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                            • Slide 141
                                                                                            • Lend Me Your Brain
                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                            • Slide 146
                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                            • Slide 149
                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                            • Slide 152
                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                            • Slide 154
                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                            • Slide 157
                                                                                            • Slide 158
                                                                                            • Slide 159
                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                            • Slide 162
                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                            • Slide 164
                                                                                            • Instant gratification vs executive gratification
                                                                                            • Slide 166
                                                                                            • Slide 167
                                                                                            • Slide 168
                                                                                            • Slide 169
                                                                                            • Slide 170
                                                                                            • Self-Talk Proficiency
                                                                                            • Self-Talk Proficiency (2)
                                                                                            • Self-Talk Proficiency (3)
                                                                                            • Self-Talk Proficiency (4)
                                                                                            • Match the Picture
                                                                                            • Slide 176
                                                                                            • Slide 177
                                                                                            • Distraction Delay Training
                                                                                            • Slide 179
                                                                                            • Slide 180
                                                                                            • Executive Estimates Training
                                                                                            • Learning Time
                                                                                            • Learning Time (2)
                                                                                            • Learning Time (3)
                                                                                            • Slide 185
                                                                                            • Slide 186
                                                                                            • Learning Time (4)
                                                                                            • Asking two questionshellip
                                                                                            • Slide 189
                                                                                            • Slide 190
                                                                                            • Key Features of Video Games
                                                                                            • Key Features of Video Games (2)
                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                            • Slide 194
                                                                                            • Slide 195
                                                                                            • Slide 196
                                                                                            • Slide 197
                                                                                            • Slide 198
                                                                                            • Slide 199
                                                                                            • Slide 200
                                                                                            • Slide 201
                                                                                            • Quarterly QI review
                                                                                            • The post-mortem
                                                                                            • Slide 204
                                                                                            • Slide 205
                                                                                            • Slide 206
                                                                                            • Slide 207
                                                                                            • Slide 208
                                                                                            • Slide 209
                                                                                            • Slide 210
                                                                                            • The ldquoBig Fiverdquo
                                                                                            • Slide 212
                                                                                            • Slide 213
                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                            • Slide 215
                                                                                            • Slide 216
                                                                                            • Slide 217
                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                            • A challengehellip
                                                                                            • Slide 222

                                                                                              Subtypes of ADHD

                                                                                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise Specifed

                                                                                              Subtypes of ADHD

                                                                                              ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                                              Specifed

                                                                                              Common comorbidities with ADHD

                                                                                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                              processing challenges

                                                                                              Common comorbidities with ADHD

                                                                                              Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                              processing challenges

                                                                                              ADHD and girls

                                                                                              ADHD and women

                                                                                              ADHD and women

                                                                                              More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                              partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                              disorganization

                                                                                              Executive FunctioningAn Overarching Theme

                                                                                              Sensory Processing Disorder Central Auditory Processing

                                                                                              Disorder ADHD and Executive Dysfunction

                                                                                              The Executive Functions

                                                                                              Internalizing speech Previewing

                                                                                              Prioritizing Tempo control Inhibition

                                                                                              The Executive Functions

                                                                                              Determining salience (whatrsquos in it for me)

                                                                                              Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                              Appropriate expectations

                                                                                              Age-appropriate expectations

                                                                                              Preschool 1-step errands Chores with cues Basic inhibition

                                                                                              Age-appropriate expectations

                                                                                              K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                              3rd ndash 5th

                                                                                              Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                              Age-appropriate expectations

                                                                                              6th ndash 8th

                                                                                              complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                              Age-appropriate expectations

                                                                                              Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                              already made Take othersrsquo perspective

                                                                                              Age-appropriate expectations

                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                              Inter-connectedness of systems Cortico-striatal system for example

                                                                                              Strategies

                                                                                              Pharmacotherapy

                                                                                              X

                                                                                              Behavioral Supports

                                                                                              A B C

                                                                                              A B C

                                                                                              behavior

                                                                                              A B C

                                                                                              consequences

                                                                                              A B C

                                                                                              antecedent

                                                                                              A B C

                                                                                              A B C

                                                                                              antecedent

                                                                                              A B C

                                                                                              antecedent

                                                                                              easy hard

                                                                                              A B C

                                                                                              consequences

                                                                                              R P

                                                                                              +

                                                                                              -

                                                                                              R+ P+

                                                                                              R- P-

                                                                                              Time Out

                                                                                              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                              Token economy

                                                                                              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                              Intrinsic motivation

                                                                                              A B C

                                                                                              consequencesX

                                                                                              A B C

                                                                                              behavior

                                                                                              Metacognition

                                                                                              Metacognitive knowledge Metacognitive strategies

                                                                                              ldquoLend Me Your Brainrdquo

                                                                                              What Does Dopamine Feel Like

                                                                                              The Physiology of Motivation and Reward

                                                                                              Preferred States What Does Dopamine Feel Like

                                                                                              1 Great experience2 Kodak moment3 The feeeeling

                                                                                              David D Nowell PhD189 May Street

                                                                                              Worcester Mass 01602DrNowellcom

                                                                                              PREFERRED STATES INVENTORY

                                                                                              wwwLulucom

                                                                                              Identify 20 peak experiences For each peak experience identify the

                                                                                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                              of that moment Name it Check the 20 peak moment-feelings for

                                                                                              clusters groupings There will probably be 4 or 5

                                                                                              PREFERRED STATES INVENTORY

                                                                                              Find a word a label for each of the groupings

                                                                                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                              ldquovaluesrdquo ways that you really like to feel

                                                                                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                              PREFERRED STATES INVENTORY

                                                                                              PREFERRED STATES INVENTORY

                                                                                              Broaden and Build

                                                                                              ldquoNeuroMalleabilityrdquo

                                                                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                              The reward-and-planning system

                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                              The reward-and-planning system

                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                              Lend Me Your Brain

                                                                                              Supporting Clients with Executive Dysfunction

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                              Too busy with current activity

                                                                                              Field dependent

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Sequence problem-solve

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Block out distractions

                                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                              - E Goldberg

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Get the reward

                                                                                              Ways the reward-and-planning system can go wrong

                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                              Instant gratification vs

                                                                                              executive gratification

                                                                                              A B C

                                                                                              behaviorx

                                                                                              Self-Talk Proficiency

                                                                                              Self-Talk Proficiency

                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                              takerdquordquo

                                                                                              Self-Talk Proficiency

                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                              Self-Talk Proficiency

                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                              thathelliprdquo

                                                                                              Match the Picture

                                                                                              Distraction Delay Training

                                                                                              Executive Estimates Training

                                                                                              X

                                                                                              Learning Time

                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                              Learning Time

                                                                                              Learning Time

                                                                                              Learning Time

                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                              Asking two questionshellip

                                                                                              Am I having fun now And is this what I set out to do

                                                                                              Am I having fun nowIs

                                                                                              this

                                                                                              what

                                                                                              I se

                                                                                              t out

                                                                                              to

                                                                                              do

                                                                                              bullYesbullYes

                                                                                              bullNobullYes

                                                                                              bullYesbullNo

                                                                                              bullNobullNo

                                                                                              Am I having fun nowIs

                                                                                              this

                                                                                              what

                                                                                              I se

                                                                                              t out

                                                                                              to

                                                                                              do

                                                                                              bullFunbullOn-task

                                                                                              bullNot funbullOn-task

                                                                                              bullFunbullNot on-task

                                                                                              bullNot funbullNot on-task

                                                                                              Key Features of Video Games

                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                              inappropriate behavior ndash never reverse this

                                                                                              Key Features of Video Games

                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                              Volkow et al 2004

                                                                                              Increase salience

                                                                                              Increase salience

                                                                                              Quarterly QI review

                                                                                              The post-mortem

                                                                                              Your 1 Organizational Tool

                                                                                              Your 1 Organizational Tool

                                                                                              Yoga read

                                                                                              Staff meeting

                                                                                              Planningsession

                                                                                              Phone calls

                                                                                              billing

                                                                                              Your 1 Organizational Tool

                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                              Your 1 Organizational Tool

                                                                                              Learn French

                                                                                              Stop smoking

                                                                                              Be a better spouse

                                                                                              The ldquoBig Fiverdquo

                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                              The ldquoBig Fiverdquo

                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                              The ldquoBig Fiverdquo

                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                              The ldquoBig Fiverdquo

                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                              The ldquoBig Fiverdquo

                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                              A CHALLENGEhellip

                                                                                              wwwDrNowellcom

                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                              DavidNowellSeminars

                                                                                              DavidNowell

                                                                                              • Slide 1
                                                                                              • hellipa challenge
                                                                                              • Slide 3
                                                                                              • Perspective of this workshophellip
                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                              • Slide 7
                                                                                              • Whatrsquos the kidrsquos deal
                                                                                              • Overview
                                                                                              • This Dense Pudding
                                                                                              • Sensory Processing Disorder
                                                                                              • Slide 12
                                                                                              • Slide 13
                                                                                              • Developmental considerations
                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                              • Slide 17
                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                              • Slide 19
                                                                                              • Strategies
                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                              • Slide 22
                                                                                              • Slide 23
                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                              • Slide 25
                                                                                              • Central Auditory Processing Disorder
                                                                                              • Slide 27
                                                                                              • Slide 28
                                                                                              • Slide 29
                                                                                              • Central Auditory Processing Disorder (2)
                                                                                              • Central Auditory Processing Disorder (3)
                                                                                              • Central Auditory Processing Disorder (4)
                                                                                              • CAPD or ADHD
                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                              • Slide 35
                                                                                              • Strategies (2)
                                                                                              • (C)APD
                                                                                              • Treatment for CAPD
                                                                                              • Treatment for CAPD (2)
                                                                                              • Self-assessment
                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                              • Slide 42
                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                              • (85 ndash X) x 365
                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                              • Core symptoms
                                                                                              • Core symptoms (2)
                                                                                              • hellipand the rest of the criteria
                                                                                              • Slide 49
                                                                                              • Functional impact of core symptoms
                                                                                              • Functional impact of core symptoms (2)
                                                                                              • Functional impact of core symptoms (3)
                                                                                              • Slide 53
                                                                                              • Functional impact of core symptoms (4)
                                                                                              • Functional impact of core symptoms (5)
                                                                                              • Functional impact of core symptoms (6)
                                                                                              • Functional impact of core symptoms (7)
                                                                                              • Functional impact of core symptoms (8)
                                                                                              • Functional impact of core symptoms (9)
                                                                                              • Subtypes of ADHD
                                                                                              • Subtypes of ADHD (2)
                                                                                              • Common comorbidities with ADHD
                                                                                              • Slide 63
                                                                                              • Common comorbidities with ADHD (2)
                                                                                              • ADHD and girls
                                                                                              • Slide 66
                                                                                              • Slide 67
                                                                                              • ADHD and women
                                                                                              • Slide 69
                                                                                              • ADHD and women (2)
                                                                                              • Executive Functioning An Overarching Theme
                                                                                              • The Executive Functions
                                                                                              • The Executive Functions (2)
                                                                                              • Slide 74
                                                                                              • Slide 75
                                                                                              • Appropriate expectations
                                                                                              • Age-appropriate expectations
                                                                                              • Age-appropriate expectations (2)
                                                                                              • Age-appropriate expectations (3)
                                                                                              • Age-appropriate expectations (4)
                                                                                              • Age-appropriate expectations (5)
                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                              • Slide 84
                                                                                              • Slide 85
                                                                                              • Strategies (3)
                                                                                              • Pharmacotherapy
                                                                                              • Behavioral Supports
                                                                                              • Slide 89
                                                                                              • Slide 90
                                                                                              • Slide 91
                                                                                              • Slide 92
                                                                                              • Slide 93
                                                                                              • Slide 94
                                                                                              • Slide 95
                                                                                              • Slide 96
                                                                                              • Slide 97
                                                                                              • Slide 98
                                                                                              • Slide 99
                                                                                              • Slide 100
                                                                                              • Slide 101
                                                                                              • Slide 102
                                                                                              • Slide 103
                                                                                              • Slide 104
                                                                                              • Slide 105
                                                                                              • Slide 106
                                                                                              • Slide 107
                                                                                              • Slide 108
                                                                                              • Slide 109
                                                                                              • Slide 110
                                                                                              • Time Out
                                                                                              • Token economy
                                                                                              • Slide 113
                                                                                              • Slide 114
                                                                                              • Slide 115
                                                                                              • Intrinsic motivation
                                                                                              • Slide 117
                                                                                              • Slide 118
                                                                                              • Slide 119
                                                                                              • Metacognition
                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                              • What Does Dopamine Feel Like
                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                              • Slide 124
                                                                                              • PREFERRED STATES INVENTORY
                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                              • Slide 128
                                                                                              • Slide 129
                                                                                              • Broaden and Build
                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                              • The reward-and-planning system
                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                              • The reward-and-planning system (2)
                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                              • Slide 141
                                                                                              • Lend Me Your Brain
                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                              • Slide 146
                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                              • Slide 149
                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                              • Slide 152
                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                              • Slide 154
                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                              • Slide 157
                                                                                              • Slide 158
                                                                                              • Slide 159
                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                              • Slide 162
                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                              • Slide 164
                                                                                              • Instant gratification vs executive gratification
                                                                                              • Slide 166
                                                                                              • Slide 167
                                                                                              • Slide 168
                                                                                              • Slide 169
                                                                                              • Slide 170
                                                                                              • Self-Talk Proficiency
                                                                                              • Self-Talk Proficiency (2)
                                                                                              • Self-Talk Proficiency (3)
                                                                                              • Self-Talk Proficiency (4)
                                                                                              • Match the Picture
                                                                                              • Slide 176
                                                                                              • Slide 177
                                                                                              • Distraction Delay Training
                                                                                              • Slide 179
                                                                                              • Slide 180
                                                                                              • Executive Estimates Training
                                                                                              • Learning Time
                                                                                              • Learning Time (2)
                                                                                              • Learning Time (3)
                                                                                              • Slide 185
                                                                                              • Slide 186
                                                                                              • Learning Time (4)
                                                                                              • Asking two questionshellip
                                                                                              • Slide 189
                                                                                              • Slide 190
                                                                                              • Key Features of Video Games
                                                                                              • Key Features of Video Games (2)
                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                              • Slide 194
                                                                                              • Slide 195
                                                                                              • Slide 196
                                                                                              • Slide 197
                                                                                              • Slide 198
                                                                                              • Slide 199
                                                                                              • Slide 200
                                                                                              • Slide 201
                                                                                              • Quarterly QI review
                                                                                              • The post-mortem
                                                                                              • Slide 204
                                                                                              • Slide 205
                                                                                              • Slide 206
                                                                                              • Slide 207
                                                                                              • Slide 208
                                                                                              • Slide 209
                                                                                              • Slide 210
                                                                                              • The ldquoBig Fiverdquo
                                                                                              • Slide 212
                                                                                              • Slide 213
                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                              • Slide 215
                                                                                              • Slide 216
                                                                                              • Slide 217
                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                              • A challengehellip
                                                                                              • Slide 222

                                                                                                Subtypes of ADHD

                                                                                                ADHD predominantly inattentive type ADHD predominantly hyperactive type ADHD combined type ADHD Not Otherwise

                                                                                                Specifed

                                                                                                Common comorbidities with ADHD

                                                                                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                                processing challenges

                                                                                                Common comorbidities with ADHD

                                                                                                Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                                processing challenges

                                                                                                ADHD and girls

                                                                                                ADHD and women

                                                                                                ADHD and women

                                                                                                More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                                partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                                disorganization

                                                                                                Executive FunctioningAn Overarching Theme

                                                                                                Sensory Processing Disorder Central Auditory Processing

                                                                                                Disorder ADHD and Executive Dysfunction

                                                                                                The Executive Functions

                                                                                                Internalizing speech Previewing

                                                                                                Prioritizing Tempo control Inhibition

                                                                                                The Executive Functions

                                                                                                Determining salience (whatrsquos in it for me)

                                                                                                Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                                Appropriate expectations

                                                                                                Age-appropriate expectations

                                                                                                Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                Age-appropriate expectations

                                                                                                K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                3rd ndash 5th

                                                                                                Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                Age-appropriate expectations

                                                                                                6th ndash 8th

                                                                                                complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                Age-appropriate expectations

                                                                                                Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                already made Take othersrsquo perspective

                                                                                                Age-appropriate expectations

                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                Inter-connectedness of systems Cortico-striatal system for example

                                                                                                Strategies

                                                                                                Pharmacotherapy

                                                                                                X

                                                                                                Behavioral Supports

                                                                                                A B C

                                                                                                A B C

                                                                                                behavior

                                                                                                A B C

                                                                                                consequences

                                                                                                A B C

                                                                                                antecedent

                                                                                                A B C

                                                                                                A B C

                                                                                                antecedent

                                                                                                A B C

                                                                                                antecedent

                                                                                                easy hard

                                                                                                A B C

                                                                                                consequences

                                                                                                R P

                                                                                                +

                                                                                                -

                                                                                                R+ P+

                                                                                                R- P-

                                                                                                Time Out

                                                                                                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                Token economy

                                                                                                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                Intrinsic motivation

                                                                                                A B C

                                                                                                consequencesX

                                                                                                A B C

                                                                                                behavior

                                                                                                Metacognition

                                                                                                Metacognitive knowledge Metacognitive strategies

                                                                                                ldquoLend Me Your Brainrdquo

                                                                                                What Does Dopamine Feel Like

                                                                                                The Physiology of Motivation and Reward

                                                                                                Preferred States What Does Dopamine Feel Like

                                                                                                1 Great experience2 Kodak moment3 The feeeeling

                                                                                                David D Nowell PhD189 May Street

                                                                                                Worcester Mass 01602DrNowellcom

                                                                                                PREFERRED STATES INVENTORY

                                                                                                wwwLulucom

                                                                                                Identify 20 peak experiences For each peak experience identify the

                                                                                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                of that moment Name it Check the 20 peak moment-feelings for

                                                                                                clusters groupings There will probably be 4 or 5

                                                                                                PREFERRED STATES INVENTORY

                                                                                                Find a word a label for each of the groupings

                                                                                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                ldquovaluesrdquo ways that you really like to feel

                                                                                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                PREFERRED STATES INVENTORY

                                                                                                PREFERRED STATES INVENTORY

                                                                                                Broaden and Build

                                                                                                ldquoNeuroMalleabilityrdquo

                                                                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                The reward-and-planning system

                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                The reward-and-planning system

                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                Lend Me Your Brain

                                                                                                Supporting Clients with Executive Dysfunction

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                Too busy with current activity

                                                                                                Field dependent

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Sequence problem-solve

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Block out distractions

                                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                - E Goldberg

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Get the reward

                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                Instant gratification vs

                                                                                                executive gratification

                                                                                                A B C

                                                                                                behaviorx

                                                                                                Self-Talk Proficiency

                                                                                                Self-Talk Proficiency

                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                takerdquordquo

                                                                                                Self-Talk Proficiency

                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                Self-Talk Proficiency

                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                thathelliprdquo

                                                                                                Match the Picture

                                                                                                Distraction Delay Training

                                                                                                Executive Estimates Training

                                                                                                X

                                                                                                Learning Time

                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                Learning Time

                                                                                                Learning Time

                                                                                                Learning Time

                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                Asking two questionshellip

                                                                                                Am I having fun now And is this what I set out to do

                                                                                                Am I having fun nowIs

                                                                                                this

                                                                                                what

                                                                                                I se

                                                                                                t out

                                                                                                to

                                                                                                do

                                                                                                bullYesbullYes

                                                                                                bullNobullYes

                                                                                                bullYesbullNo

                                                                                                bullNobullNo

                                                                                                Am I having fun nowIs

                                                                                                this

                                                                                                what

                                                                                                I se

                                                                                                t out

                                                                                                to

                                                                                                do

                                                                                                bullFunbullOn-task

                                                                                                bullNot funbullOn-task

                                                                                                bullFunbullNot on-task

                                                                                                bullNot funbullNot on-task

                                                                                                Key Features of Video Games

                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                inappropriate behavior ndash never reverse this

                                                                                                Key Features of Video Games

                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                Volkow et al 2004

                                                                                                Increase salience

                                                                                                Increase salience

                                                                                                Quarterly QI review

                                                                                                The post-mortem

                                                                                                Your 1 Organizational Tool

                                                                                                Your 1 Organizational Tool

                                                                                                Yoga read

                                                                                                Staff meeting

                                                                                                Planningsession

                                                                                                Phone calls

                                                                                                billing

                                                                                                Your 1 Organizational Tool

                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                Your 1 Organizational Tool

                                                                                                Learn French

                                                                                                Stop smoking

                                                                                                Be a better spouse

                                                                                                The ldquoBig Fiverdquo

                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                The ldquoBig Fiverdquo

                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                The ldquoBig Fiverdquo

                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                The ldquoBig Fiverdquo

                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                The ldquoBig Fiverdquo

                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                A CHALLENGEhellip

                                                                                                wwwDrNowellcom

                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                DavidNowellSeminars

                                                                                                DavidNowell

                                                                                                • Slide 1
                                                                                                • hellipa challenge
                                                                                                • Slide 3
                                                                                                • Perspective of this workshophellip
                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                • Slide 7
                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                • Overview
                                                                                                • This Dense Pudding
                                                                                                • Sensory Processing Disorder
                                                                                                • Slide 12
                                                                                                • Slide 13
                                                                                                • Developmental considerations
                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                • Slide 17
                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                • Slide 19
                                                                                                • Strategies
                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                • Slide 22
                                                                                                • Slide 23
                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                • Slide 25
                                                                                                • Central Auditory Processing Disorder
                                                                                                • Slide 27
                                                                                                • Slide 28
                                                                                                • Slide 29
                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                • CAPD or ADHD
                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                • Slide 35
                                                                                                • Strategies (2)
                                                                                                • (C)APD
                                                                                                • Treatment for CAPD
                                                                                                • Treatment for CAPD (2)
                                                                                                • Self-assessment
                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                • Slide 42
                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                • (85 ndash X) x 365
                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                • Core symptoms
                                                                                                • Core symptoms (2)
                                                                                                • hellipand the rest of the criteria
                                                                                                • Slide 49
                                                                                                • Functional impact of core symptoms
                                                                                                • Functional impact of core symptoms (2)
                                                                                                • Functional impact of core symptoms (3)
                                                                                                • Slide 53
                                                                                                • Functional impact of core symptoms (4)
                                                                                                • Functional impact of core symptoms (5)
                                                                                                • Functional impact of core symptoms (6)
                                                                                                • Functional impact of core symptoms (7)
                                                                                                • Functional impact of core symptoms (8)
                                                                                                • Functional impact of core symptoms (9)
                                                                                                • Subtypes of ADHD
                                                                                                • Subtypes of ADHD (2)
                                                                                                • Common comorbidities with ADHD
                                                                                                • Slide 63
                                                                                                • Common comorbidities with ADHD (2)
                                                                                                • ADHD and girls
                                                                                                • Slide 66
                                                                                                • Slide 67
                                                                                                • ADHD and women
                                                                                                • Slide 69
                                                                                                • ADHD and women (2)
                                                                                                • Executive Functioning An Overarching Theme
                                                                                                • The Executive Functions
                                                                                                • The Executive Functions (2)
                                                                                                • Slide 74
                                                                                                • Slide 75
                                                                                                • Appropriate expectations
                                                                                                • Age-appropriate expectations
                                                                                                • Age-appropriate expectations (2)
                                                                                                • Age-appropriate expectations (3)
                                                                                                • Age-appropriate expectations (4)
                                                                                                • Age-appropriate expectations (5)
                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                • Slide 84
                                                                                                • Slide 85
                                                                                                • Strategies (3)
                                                                                                • Pharmacotherapy
                                                                                                • Behavioral Supports
                                                                                                • Slide 89
                                                                                                • Slide 90
                                                                                                • Slide 91
                                                                                                • Slide 92
                                                                                                • Slide 93
                                                                                                • Slide 94
                                                                                                • Slide 95
                                                                                                • Slide 96
                                                                                                • Slide 97
                                                                                                • Slide 98
                                                                                                • Slide 99
                                                                                                • Slide 100
                                                                                                • Slide 101
                                                                                                • Slide 102
                                                                                                • Slide 103
                                                                                                • Slide 104
                                                                                                • Slide 105
                                                                                                • Slide 106
                                                                                                • Slide 107
                                                                                                • Slide 108
                                                                                                • Slide 109
                                                                                                • Slide 110
                                                                                                • Time Out
                                                                                                • Token economy
                                                                                                • Slide 113
                                                                                                • Slide 114
                                                                                                • Slide 115
                                                                                                • Intrinsic motivation
                                                                                                • Slide 117
                                                                                                • Slide 118
                                                                                                • Slide 119
                                                                                                • Metacognition
                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                • What Does Dopamine Feel Like
                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                • Slide 124
                                                                                                • PREFERRED STATES INVENTORY
                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                • Slide 128
                                                                                                • Slide 129
                                                                                                • Broaden and Build
                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                • The reward-and-planning system
                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                • The reward-and-planning system (2)
                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                • Slide 141
                                                                                                • Lend Me Your Brain
                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                • Slide 146
                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                • Slide 149
                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                • Slide 152
                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                • Slide 154
                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                • Slide 157
                                                                                                • Slide 158
                                                                                                • Slide 159
                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                • Slide 162
                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                • Slide 164
                                                                                                • Instant gratification vs executive gratification
                                                                                                • Slide 166
                                                                                                • Slide 167
                                                                                                • Slide 168
                                                                                                • Slide 169
                                                                                                • Slide 170
                                                                                                • Self-Talk Proficiency
                                                                                                • Self-Talk Proficiency (2)
                                                                                                • Self-Talk Proficiency (3)
                                                                                                • Self-Talk Proficiency (4)
                                                                                                • Match the Picture
                                                                                                • Slide 176
                                                                                                • Slide 177
                                                                                                • Distraction Delay Training
                                                                                                • Slide 179
                                                                                                • Slide 180
                                                                                                • Executive Estimates Training
                                                                                                • Learning Time
                                                                                                • Learning Time (2)
                                                                                                • Learning Time (3)
                                                                                                • Slide 185
                                                                                                • Slide 186
                                                                                                • Learning Time (4)
                                                                                                • Asking two questionshellip
                                                                                                • Slide 189
                                                                                                • Slide 190
                                                                                                • Key Features of Video Games
                                                                                                • Key Features of Video Games (2)
                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                • Slide 194
                                                                                                • Slide 195
                                                                                                • Slide 196
                                                                                                • Slide 197
                                                                                                • Slide 198
                                                                                                • Slide 199
                                                                                                • Slide 200
                                                                                                • Slide 201
                                                                                                • Quarterly QI review
                                                                                                • The post-mortem
                                                                                                • Slide 204
                                                                                                • Slide 205
                                                                                                • Slide 206
                                                                                                • Slide 207
                                                                                                • Slide 208
                                                                                                • Slide 209
                                                                                                • Slide 210
                                                                                                • The ldquoBig Fiverdquo
                                                                                                • Slide 212
                                                                                                • Slide 213
                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                • Slide 215
                                                                                                • Slide 216
                                                                                                • Slide 217
                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                • A challengehellip
                                                                                                • Slide 222

                                                                                                  Common comorbidities with ADHD

                                                                                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                                  processing challenges

                                                                                                  Common comorbidities with ADHD

                                                                                                  Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                                  processing challenges

                                                                                                  ADHD and girls

                                                                                                  ADHD and women

                                                                                                  ADHD and women

                                                                                                  More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                                  partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                                  disorganization

                                                                                                  Executive FunctioningAn Overarching Theme

                                                                                                  Sensory Processing Disorder Central Auditory Processing

                                                                                                  Disorder ADHD and Executive Dysfunction

                                                                                                  The Executive Functions

                                                                                                  Internalizing speech Previewing

                                                                                                  Prioritizing Tempo control Inhibition

                                                                                                  The Executive Functions

                                                                                                  Determining salience (whatrsquos in it for me)

                                                                                                  Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                                  Appropriate expectations

                                                                                                  Age-appropriate expectations

                                                                                                  Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                  Age-appropriate expectations

                                                                                                  K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                  3rd ndash 5th

                                                                                                  Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                  Age-appropriate expectations

                                                                                                  6th ndash 8th

                                                                                                  complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                  Age-appropriate expectations

                                                                                                  Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                  already made Take othersrsquo perspective

                                                                                                  Age-appropriate expectations

                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                  Inter-connectedness of systems Cortico-striatal system for example

                                                                                                  Strategies

                                                                                                  Pharmacotherapy

                                                                                                  X

                                                                                                  Behavioral Supports

                                                                                                  A B C

                                                                                                  A B C

                                                                                                  behavior

                                                                                                  A B C

                                                                                                  consequences

                                                                                                  A B C

                                                                                                  antecedent

                                                                                                  A B C

                                                                                                  A B C

                                                                                                  antecedent

                                                                                                  A B C

                                                                                                  antecedent

                                                                                                  easy hard

                                                                                                  A B C

                                                                                                  consequences

                                                                                                  R P

                                                                                                  +

                                                                                                  -

                                                                                                  R+ P+

                                                                                                  R- P-

                                                                                                  Time Out

                                                                                                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                  Token economy

                                                                                                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                  Intrinsic motivation

                                                                                                  A B C

                                                                                                  consequencesX

                                                                                                  A B C

                                                                                                  behavior

                                                                                                  Metacognition

                                                                                                  Metacognitive knowledge Metacognitive strategies

                                                                                                  ldquoLend Me Your Brainrdquo

                                                                                                  What Does Dopamine Feel Like

                                                                                                  The Physiology of Motivation and Reward

                                                                                                  Preferred States What Does Dopamine Feel Like

                                                                                                  1 Great experience2 Kodak moment3 The feeeeling

                                                                                                  David D Nowell PhD189 May Street

                                                                                                  Worcester Mass 01602DrNowellcom

                                                                                                  PREFERRED STATES INVENTORY

                                                                                                  wwwLulucom

                                                                                                  Identify 20 peak experiences For each peak experience identify the

                                                                                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                  of that moment Name it Check the 20 peak moment-feelings for

                                                                                                  clusters groupings There will probably be 4 or 5

                                                                                                  PREFERRED STATES INVENTORY

                                                                                                  Find a word a label for each of the groupings

                                                                                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                  ldquovaluesrdquo ways that you really like to feel

                                                                                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                  PREFERRED STATES INVENTORY

                                                                                                  PREFERRED STATES INVENTORY

                                                                                                  Broaden and Build

                                                                                                  ldquoNeuroMalleabilityrdquo

                                                                                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                  The reward-and-planning system

                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                  The reward-and-planning system

                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                  Lend Me Your Brain

                                                                                                  Supporting Clients with Executive Dysfunction

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                  Too busy with current activity

                                                                                                  Field dependent

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Sequence problem-solve

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Block out distractions

                                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                  - E Goldberg

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Get the reward

                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                  Instant gratification vs

                                                                                                  executive gratification

                                                                                                  A B C

                                                                                                  behaviorx

                                                                                                  Self-Talk Proficiency

                                                                                                  Self-Talk Proficiency

                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                  takerdquordquo

                                                                                                  Self-Talk Proficiency

                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                  Self-Talk Proficiency

                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                  thathelliprdquo

                                                                                                  Match the Picture

                                                                                                  Distraction Delay Training

                                                                                                  Executive Estimates Training

                                                                                                  X

                                                                                                  Learning Time

                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                  Learning Time

                                                                                                  Learning Time

                                                                                                  Learning Time

                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                  Asking two questionshellip

                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                  Am I having fun nowIs

                                                                                                  this

                                                                                                  what

                                                                                                  I se

                                                                                                  t out

                                                                                                  to

                                                                                                  do

                                                                                                  bullYesbullYes

                                                                                                  bullNobullYes

                                                                                                  bullYesbullNo

                                                                                                  bullNobullNo

                                                                                                  Am I having fun nowIs

                                                                                                  this

                                                                                                  what

                                                                                                  I se

                                                                                                  t out

                                                                                                  to

                                                                                                  do

                                                                                                  bullFunbullOn-task

                                                                                                  bullNot funbullOn-task

                                                                                                  bullFunbullNot on-task

                                                                                                  bullNot funbullNot on-task

                                                                                                  Key Features of Video Games

                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                  Key Features of Video Games

                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                  Volkow et al 2004

                                                                                                  Increase salience

                                                                                                  Increase salience

                                                                                                  Quarterly QI review

                                                                                                  The post-mortem

                                                                                                  Your 1 Organizational Tool

                                                                                                  Your 1 Organizational Tool

                                                                                                  Yoga read

                                                                                                  Staff meeting

                                                                                                  Planningsession

                                                                                                  Phone calls

                                                                                                  billing

                                                                                                  Your 1 Organizational Tool

                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                  Your 1 Organizational Tool

                                                                                                  Learn French

                                                                                                  Stop smoking

                                                                                                  Be a better spouse

                                                                                                  The ldquoBig Fiverdquo

                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                  The ldquoBig Fiverdquo

                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                  The ldquoBig Fiverdquo

                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                  The ldquoBig Fiverdquo

                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                  The ldquoBig Fiverdquo

                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                  A CHALLENGEhellip

                                                                                                  wwwDrNowellcom

                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                  DavidNowellSeminars

                                                                                                  DavidNowell

                                                                                                  • Slide 1
                                                                                                  • hellipa challenge
                                                                                                  • Slide 3
                                                                                                  • Perspective of this workshophellip
                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                  • Slide 7
                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                  • Overview
                                                                                                  • This Dense Pudding
                                                                                                  • Sensory Processing Disorder
                                                                                                  • Slide 12
                                                                                                  • Slide 13
                                                                                                  • Developmental considerations
                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                  • Slide 17
                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                  • Slide 19
                                                                                                  • Strategies
                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                  • Slide 22
                                                                                                  • Slide 23
                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                  • Slide 25
                                                                                                  • Central Auditory Processing Disorder
                                                                                                  • Slide 27
                                                                                                  • Slide 28
                                                                                                  • Slide 29
                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                  • CAPD or ADHD
                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                  • Slide 35
                                                                                                  • Strategies (2)
                                                                                                  • (C)APD
                                                                                                  • Treatment for CAPD
                                                                                                  • Treatment for CAPD (2)
                                                                                                  • Self-assessment
                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                  • Slide 42
                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                  • (85 ndash X) x 365
                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                  • Core symptoms
                                                                                                  • Core symptoms (2)
                                                                                                  • hellipand the rest of the criteria
                                                                                                  • Slide 49
                                                                                                  • Functional impact of core symptoms
                                                                                                  • Functional impact of core symptoms (2)
                                                                                                  • Functional impact of core symptoms (3)
                                                                                                  • Slide 53
                                                                                                  • Functional impact of core symptoms (4)
                                                                                                  • Functional impact of core symptoms (5)
                                                                                                  • Functional impact of core symptoms (6)
                                                                                                  • Functional impact of core symptoms (7)
                                                                                                  • Functional impact of core symptoms (8)
                                                                                                  • Functional impact of core symptoms (9)
                                                                                                  • Subtypes of ADHD
                                                                                                  • Subtypes of ADHD (2)
                                                                                                  • Common comorbidities with ADHD
                                                                                                  • Slide 63
                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                  • ADHD and girls
                                                                                                  • Slide 66
                                                                                                  • Slide 67
                                                                                                  • ADHD and women
                                                                                                  • Slide 69
                                                                                                  • ADHD and women (2)
                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                  • The Executive Functions
                                                                                                  • The Executive Functions (2)
                                                                                                  • Slide 74
                                                                                                  • Slide 75
                                                                                                  • Appropriate expectations
                                                                                                  • Age-appropriate expectations
                                                                                                  • Age-appropriate expectations (2)
                                                                                                  • Age-appropriate expectations (3)
                                                                                                  • Age-appropriate expectations (4)
                                                                                                  • Age-appropriate expectations (5)
                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                  • Slide 84
                                                                                                  • Slide 85
                                                                                                  • Strategies (3)
                                                                                                  • Pharmacotherapy
                                                                                                  • Behavioral Supports
                                                                                                  • Slide 89
                                                                                                  • Slide 90
                                                                                                  • Slide 91
                                                                                                  • Slide 92
                                                                                                  • Slide 93
                                                                                                  • Slide 94
                                                                                                  • Slide 95
                                                                                                  • Slide 96
                                                                                                  • Slide 97
                                                                                                  • Slide 98
                                                                                                  • Slide 99
                                                                                                  • Slide 100
                                                                                                  • Slide 101
                                                                                                  • Slide 102
                                                                                                  • Slide 103
                                                                                                  • Slide 104
                                                                                                  • Slide 105
                                                                                                  • Slide 106
                                                                                                  • Slide 107
                                                                                                  • Slide 108
                                                                                                  • Slide 109
                                                                                                  • Slide 110
                                                                                                  • Time Out
                                                                                                  • Token economy
                                                                                                  • Slide 113
                                                                                                  • Slide 114
                                                                                                  • Slide 115
                                                                                                  • Intrinsic motivation
                                                                                                  • Slide 117
                                                                                                  • Slide 118
                                                                                                  • Slide 119
                                                                                                  • Metacognition
                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                  • What Does Dopamine Feel Like
                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                  • Slide 124
                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                  • Slide 128
                                                                                                  • Slide 129
                                                                                                  • Broaden and Build
                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                  • The reward-and-planning system
                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                  • The reward-and-planning system (2)
                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                  • Slide 141
                                                                                                  • Lend Me Your Brain
                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                  • Slide 146
                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                  • Slide 149
                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                  • Slide 152
                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                  • Slide 154
                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                  • Slide 157
                                                                                                  • Slide 158
                                                                                                  • Slide 159
                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                  • Slide 162
                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                  • Slide 164
                                                                                                  • Instant gratification vs executive gratification
                                                                                                  • Slide 166
                                                                                                  • Slide 167
                                                                                                  • Slide 168
                                                                                                  • Slide 169
                                                                                                  • Slide 170
                                                                                                  • Self-Talk Proficiency
                                                                                                  • Self-Talk Proficiency (2)
                                                                                                  • Self-Talk Proficiency (3)
                                                                                                  • Self-Talk Proficiency (4)
                                                                                                  • Match the Picture
                                                                                                  • Slide 176
                                                                                                  • Slide 177
                                                                                                  • Distraction Delay Training
                                                                                                  • Slide 179
                                                                                                  • Slide 180
                                                                                                  • Executive Estimates Training
                                                                                                  • Learning Time
                                                                                                  • Learning Time (2)
                                                                                                  • Learning Time (3)
                                                                                                  • Slide 185
                                                                                                  • Slide 186
                                                                                                  • Learning Time (4)
                                                                                                  • Asking two questionshellip
                                                                                                  • Slide 189
                                                                                                  • Slide 190
                                                                                                  • Key Features of Video Games
                                                                                                  • Key Features of Video Games (2)
                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                  • Slide 194
                                                                                                  • Slide 195
                                                                                                  • Slide 196
                                                                                                  • Slide 197
                                                                                                  • Slide 198
                                                                                                  • Slide 199
                                                                                                  • Slide 200
                                                                                                  • Slide 201
                                                                                                  • Quarterly QI review
                                                                                                  • The post-mortem
                                                                                                  • Slide 204
                                                                                                  • Slide 205
                                                                                                  • Slide 206
                                                                                                  • Slide 207
                                                                                                  • Slide 208
                                                                                                  • Slide 209
                                                                                                  • Slide 210
                                                                                                  • The ldquoBig Fiverdquo
                                                                                                  • Slide 212
                                                                                                  • Slide 213
                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                  • Slide 215
                                                                                                  • Slide 216
                                                                                                  • Slide 217
                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                  • A challengehellip
                                                                                                  • Slide 222

                                                                                                    Common comorbidities with ADHD

                                                                                                    Learning disorder Behavioral disorder Anxiety Depression Substance abuse Sensory processing and auditory

                                                                                                    processing challenges

                                                                                                    ADHD and girls

                                                                                                    ADHD and women

                                                                                                    ADHD and women

                                                                                                    More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                                    partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                                    disorganization

                                                                                                    Executive FunctioningAn Overarching Theme

                                                                                                    Sensory Processing Disorder Central Auditory Processing

                                                                                                    Disorder ADHD and Executive Dysfunction

                                                                                                    The Executive Functions

                                                                                                    Internalizing speech Previewing

                                                                                                    Prioritizing Tempo control Inhibition

                                                                                                    The Executive Functions

                                                                                                    Determining salience (whatrsquos in it for me)

                                                                                                    Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                                    Appropriate expectations

                                                                                                    Age-appropriate expectations

                                                                                                    Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                    Age-appropriate expectations

                                                                                                    K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                    3rd ndash 5th

                                                                                                    Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                    Age-appropriate expectations

                                                                                                    6th ndash 8th

                                                                                                    complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                    Age-appropriate expectations

                                                                                                    Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                    already made Take othersrsquo perspective

                                                                                                    Age-appropriate expectations

                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                    Inter-connectedness of systems Cortico-striatal system for example

                                                                                                    Strategies

                                                                                                    Pharmacotherapy

                                                                                                    X

                                                                                                    Behavioral Supports

                                                                                                    A B C

                                                                                                    A B C

                                                                                                    behavior

                                                                                                    A B C

                                                                                                    consequences

                                                                                                    A B C

                                                                                                    antecedent

                                                                                                    A B C

                                                                                                    A B C

                                                                                                    antecedent

                                                                                                    A B C

                                                                                                    antecedent

                                                                                                    easy hard

                                                                                                    A B C

                                                                                                    consequences

                                                                                                    R P

                                                                                                    +

                                                                                                    -

                                                                                                    R+ P+

                                                                                                    R- P-

                                                                                                    Time Out

                                                                                                    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                    Token economy

                                                                                                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                    Intrinsic motivation

                                                                                                    A B C

                                                                                                    consequencesX

                                                                                                    A B C

                                                                                                    behavior

                                                                                                    Metacognition

                                                                                                    Metacognitive knowledge Metacognitive strategies

                                                                                                    ldquoLend Me Your Brainrdquo

                                                                                                    What Does Dopamine Feel Like

                                                                                                    The Physiology of Motivation and Reward

                                                                                                    Preferred States What Does Dopamine Feel Like

                                                                                                    1 Great experience2 Kodak moment3 The feeeeling

                                                                                                    David D Nowell PhD189 May Street

                                                                                                    Worcester Mass 01602DrNowellcom

                                                                                                    PREFERRED STATES INVENTORY

                                                                                                    wwwLulucom

                                                                                                    Identify 20 peak experiences For each peak experience identify the

                                                                                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                    of that moment Name it Check the 20 peak moment-feelings for

                                                                                                    clusters groupings There will probably be 4 or 5

                                                                                                    PREFERRED STATES INVENTORY

                                                                                                    Find a word a label for each of the groupings

                                                                                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                    ldquovaluesrdquo ways that you really like to feel

                                                                                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                    PREFERRED STATES INVENTORY

                                                                                                    PREFERRED STATES INVENTORY

                                                                                                    Broaden and Build

                                                                                                    ldquoNeuroMalleabilityrdquo

                                                                                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                    The reward-and-planning system

                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                    The reward-and-planning system

                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                    Lend Me Your Brain

                                                                                                    Supporting Clients with Executive Dysfunction

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                    Too busy with current activity

                                                                                                    Field dependent

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Sequence problem-solve

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Block out distractions

                                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                    - E Goldberg

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Get the reward

                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                    Instant gratification vs

                                                                                                    executive gratification

                                                                                                    A B C

                                                                                                    behaviorx

                                                                                                    Self-Talk Proficiency

                                                                                                    Self-Talk Proficiency

                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                    takerdquordquo

                                                                                                    Self-Talk Proficiency

                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                    Self-Talk Proficiency

                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                    thathelliprdquo

                                                                                                    Match the Picture

                                                                                                    Distraction Delay Training

                                                                                                    Executive Estimates Training

                                                                                                    X

                                                                                                    Learning Time

                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                    Learning Time

                                                                                                    Learning Time

                                                                                                    Learning Time

                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                    Asking two questionshellip

                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                    Am I having fun nowIs

                                                                                                    this

                                                                                                    what

                                                                                                    I se

                                                                                                    t out

                                                                                                    to

                                                                                                    do

                                                                                                    bullYesbullYes

                                                                                                    bullNobullYes

                                                                                                    bullYesbullNo

                                                                                                    bullNobullNo

                                                                                                    Am I having fun nowIs

                                                                                                    this

                                                                                                    what

                                                                                                    I se

                                                                                                    t out

                                                                                                    to

                                                                                                    do

                                                                                                    bullFunbullOn-task

                                                                                                    bullNot funbullOn-task

                                                                                                    bullFunbullNot on-task

                                                                                                    bullNot funbullNot on-task

                                                                                                    Key Features of Video Games

                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                    Key Features of Video Games

                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                    Volkow et al 2004

                                                                                                    Increase salience

                                                                                                    Increase salience

                                                                                                    Quarterly QI review

                                                                                                    The post-mortem

                                                                                                    Your 1 Organizational Tool

                                                                                                    Your 1 Organizational Tool

                                                                                                    Yoga read

                                                                                                    Staff meeting

                                                                                                    Planningsession

                                                                                                    Phone calls

                                                                                                    billing

                                                                                                    Your 1 Organizational Tool

                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                    Your 1 Organizational Tool

                                                                                                    Learn French

                                                                                                    Stop smoking

                                                                                                    Be a better spouse

                                                                                                    The ldquoBig Fiverdquo

                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                    The ldquoBig Fiverdquo

                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                    The ldquoBig Fiverdquo

                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                    The ldquoBig Fiverdquo

                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                    The ldquoBig Fiverdquo

                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                    A CHALLENGEhellip

                                                                                                    wwwDrNowellcom

                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                    DavidNowellSeminars

                                                                                                    DavidNowell

                                                                                                    • Slide 1
                                                                                                    • hellipa challenge
                                                                                                    • Slide 3
                                                                                                    • Perspective of this workshophellip
                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                    • Slide 7
                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                    • Overview
                                                                                                    • This Dense Pudding
                                                                                                    • Sensory Processing Disorder
                                                                                                    • Slide 12
                                                                                                    • Slide 13
                                                                                                    • Developmental considerations
                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                    • Slide 17
                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                    • Slide 19
                                                                                                    • Strategies
                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                    • Slide 22
                                                                                                    • Slide 23
                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                    • Slide 25
                                                                                                    • Central Auditory Processing Disorder
                                                                                                    • Slide 27
                                                                                                    • Slide 28
                                                                                                    • Slide 29
                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                    • CAPD or ADHD
                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                    • Slide 35
                                                                                                    • Strategies (2)
                                                                                                    • (C)APD
                                                                                                    • Treatment for CAPD
                                                                                                    • Treatment for CAPD (2)
                                                                                                    • Self-assessment
                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                    • Slide 42
                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                    • (85 ndash X) x 365
                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                    • Core symptoms
                                                                                                    • Core symptoms (2)
                                                                                                    • hellipand the rest of the criteria
                                                                                                    • Slide 49
                                                                                                    • Functional impact of core symptoms
                                                                                                    • Functional impact of core symptoms (2)
                                                                                                    • Functional impact of core symptoms (3)
                                                                                                    • Slide 53
                                                                                                    • Functional impact of core symptoms (4)
                                                                                                    • Functional impact of core symptoms (5)
                                                                                                    • Functional impact of core symptoms (6)
                                                                                                    • Functional impact of core symptoms (7)
                                                                                                    • Functional impact of core symptoms (8)
                                                                                                    • Functional impact of core symptoms (9)
                                                                                                    • Subtypes of ADHD
                                                                                                    • Subtypes of ADHD (2)
                                                                                                    • Common comorbidities with ADHD
                                                                                                    • Slide 63
                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                    • ADHD and girls
                                                                                                    • Slide 66
                                                                                                    • Slide 67
                                                                                                    • ADHD and women
                                                                                                    • Slide 69
                                                                                                    • ADHD and women (2)
                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                    • The Executive Functions
                                                                                                    • The Executive Functions (2)
                                                                                                    • Slide 74
                                                                                                    • Slide 75
                                                                                                    • Appropriate expectations
                                                                                                    • Age-appropriate expectations
                                                                                                    • Age-appropriate expectations (2)
                                                                                                    • Age-appropriate expectations (3)
                                                                                                    • Age-appropriate expectations (4)
                                                                                                    • Age-appropriate expectations (5)
                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                    • Slide 84
                                                                                                    • Slide 85
                                                                                                    • Strategies (3)
                                                                                                    • Pharmacotherapy
                                                                                                    • Behavioral Supports
                                                                                                    • Slide 89
                                                                                                    • Slide 90
                                                                                                    • Slide 91
                                                                                                    • Slide 92
                                                                                                    • Slide 93
                                                                                                    • Slide 94
                                                                                                    • Slide 95
                                                                                                    • Slide 96
                                                                                                    • Slide 97
                                                                                                    • Slide 98
                                                                                                    • Slide 99
                                                                                                    • Slide 100
                                                                                                    • Slide 101
                                                                                                    • Slide 102
                                                                                                    • Slide 103
                                                                                                    • Slide 104
                                                                                                    • Slide 105
                                                                                                    • Slide 106
                                                                                                    • Slide 107
                                                                                                    • Slide 108
                                                                                                    • Slide 109
                                                                                                    • Slide 110
                                                                                                    • Time Out
                                                                                                    • Token economy
                                                                                                    • Slide 113
                                                                                                    • Slide 114
                                                                                                    • Slide 115
                                                                                                    • Intrinsic motivation
                                                                                                    • Slide 117
                                                                                                    • Slide 118
                                                                                                    • Slide 119
                                                                                                    • Metacognition
                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                    • What Does Dopamine Feel Like
                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                    • Slide 124
                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                    • Slide 128
                                                                                                    • Slide 129
                                                                                                    • Broaden and Build
                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                    • The reward-and-planning system
                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                    • The reward-and-planning system (2)
                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                    • Slide 141
                                                                                                    • Lend Me Your Brain
                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                    • Slide 146
                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                    • Slide 149
                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                    • Slide 152
                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                    • Slide 154
                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                    • Slide 157
                                                                                                    • Slide 158
                                                                                                    • Slide 159
                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                    • Slide 162
                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                    • Slide 164
                                                                                                    • Instant gratification vs executive gratification
                                                                                                    • Slide 166
                                                                                                    • Slide 167
                                                                                                    • Slide 168
                                                                                                    • Slide 169
                                                                                                    • Slide 170
                                                                                                    • Self-Talk Proficiency
                                                                                                    • Self-Talk Proficiency (2)
                                                                                                    • Self-Talk Proficiency (3)
                                                                                                    • Self-Talk Proficiency (4)
                                                                                                    • Match the Picture
                                                                                                    • Slide 176
                                                                                                    • Slide 177
                                                                                                    • Distraction Delay Training
                                                                                                    • Slide 179
                                                                                                    • Slide 180
                                                                                                    • Executive Estimates Training
                                                                                                    • Learning Time
                                                                                                    • Learning Time (2)
                                                                                                    • Learning Time (3)
                                                                                                    • Slide 185
                                                                                                    • Slide 186
                                                                                                    • Learning Time (4)
                                                                                                    • Asking two questionshellip
                                                                                                    • Slide 189
                                                                                                    • Slide 190
                                                                                                    • Key Features of Video Games
                                                                                                    • Key Features of Video Games (2)
                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                    • Slide 194
                                                                                                    • Slide 195
                                                                                                    • Slide 196
                                                                                                    • Slide 197
                                                                                                    • Slide 198
                                                                                                    • Slide 199
                                                                                                    • Slide 200
                                                                                                    • Slide 201
                                                                                                    • Quarterly QI review
                                                                                                    • The post-mortem
                                                                                                    • Slide 204
                                                                                                    • Slide 205
                                                                                                    • Slide 206
                                                                                                    • Slide 207
                                                                                                    • Slide 208
                                                                                                    • Slide 209
                                                                                                    • Slide 210
                                                                                                    • The ldquoBig Fiverdquo
                                                                                                    • Slide 212
                                                                                                    • Slide 213
                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                    • Slide 215
                                                                                                    • Slide 216
                                                                                                    • Slide 217
                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                    • A challengehellip
                                                                                                    • Slide 222

                                                                                                      ADHD and girls

                                                                                                      ADHD and women

                                                                                                      ADHD and women

                                                                                                      More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                                      partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                                      disorganization

                                                                                                      Executive FunctioningAn Overarching Theme

                                                                                                      Sensory Processing Disorder Central Auditory Processing

                                                                                                      Disorder ADHD and Executive Dysfunction

                                                                                                      The Executive Functions

                                                                                                      Internalizing speech Previewing

                                                                                                      Prioritizing Tempo control Inhibition

                                                                                                      The Executive Functions

                                                                                                      Determining salience (whatrsquos in it for me)

                                                                                                      Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                                      Appropriate expectations

                                                                                                      Age-appropriate expectations

                                                                                                      Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                      Age-appropriate expectations

                                                                                                      K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                      3rd ndash 5th

                                                                                                      Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                      Age-appropriate expectations

                                                                                                      6th ndash 8th

                                                                                                      complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                      Age-appropriate expectations

                                                                                                      Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                      already made Take othersrsquo perspective

                                                                                                      Age-appropriate expectations

                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                      Inter-connectedness of systems Cortico-striatal system for example

                                                                                                      Strategies

                                                                                                      Pharmacotherapy

                                                                                                      X

                                                                                                      Behavioral Supports

                                                                                                      A B C

                                                                                                      A B C

                                                                                                      behavior

                                                                                                      A B C

                                                                                                      consequences

                                                                                                      A B C

                                                                                                      antecedent

                                                                                                      A B C

                                                                                                      A B C

                                                                                                      antecedent

                                                                                                      A B C

                                                                                                      antecedent

                                                                                                      easy hard

                                                                                                      A B C

                                                                                                      consequences

                                                                                                      R P

                                                                                                      +

                                                                                                      -

                                                                                                      R+ P+

                                                                                                      R- P-

                                                                                                      Time Out

                                                                                                      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                      Token economy

                                                                                                      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                      Intrinsic motivation

                                                                                                      A B C

                                                                                                      consequencesX

                                                                                                      A B C

                                                                                                      behavior

                                                                                                      Metacognition

                                                                                                      Metacognitive knowledge Metacognitive strategies

                                                                                                      ldquoLend Me Your Brainrdquo

                                                                                                      What Does Dopamine Feel Like

                                                                                                      The Physiology of Motivation and Reward

                                                                                                      Preferred States What Does Dopamine Feel Like

                                                                                                      1 Great experience2 Kodak moment3 The feeeeling

                                                                                                      David D Nowell PhD189 May Street

                                                                                                      Worcester Mass 01602DrNowellcom

                                                                                                      PREFERRED STATES INVENTORY

                                                                                                      wwwLulucom

                                                                                                      Identify 20 peak experiences For each peak experience identify the

                                                                                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                      of that moment Name it Check the 20 peak moment-feelings for

                                                                                                      clusters groupings There will probably be 4 or 5

                                                                                                      PREFERRED STATES INVENTORY

                                                                                                      Find a word a label for each of the groupings

                                                                                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                      ldquovaluesrdquo ways that you really like to feel

                                                                                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                      PREFERRED STATES INVENTORY

                                                                                                      PREFERRED STATES INVENTORY

                                                                                                      Broaden and Build

                                                                                                      ldquoNeuroMalleabilityrdquo

                                                                                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                      The reward-and-planning system

                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                      The reward-and-planning system

                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                      Lend Me Your Brain

                                                                                                      Supporting Clients with Executive Dysfunction

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                      Too busy with current activity

                                                                                                      Field dependent

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Sequence problem-solve

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Block out distractions

                                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                      - E Goldberg

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Get the reward

                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                      Instant gratification vs

                                                                                                      executive gratification

                                                                                                      A B C

                                                                                                      behaviorx

                                                                                                      Self-Talk Proficiency

                                                                                                      Self-Talk Proficiency

                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                      takerdquordquo

                                                                                                      Self-Talk Proficiency

                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                      Self-Talk Proficiency

                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                      thathelliprdquo

                                                                                                      Match the Picture

                                                                                                      Distraction Delay Training

                                                                                                      Executive Estimates Training

                                                                                                      X

                                                                                                      Learning Time

                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                      Learning Time

                                                                                                      Learning Time

                                                                                                      Learning Time

                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                      Asking two questionshellip

                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                      Am I having fun nowIs

                                                                                                      this

                                                                                                      what

                                                                                                      I se

                                                                                                      t out

                                                                                                      to

                                                                                                      do

                                                                                                      bullYesbullYes

                                                                                                      bullNobullYes

                                                                                                      bullYesbullNo

                                                                                                      bullNobullNo

                                                                                                      Am I having fun nowIs

                                                                                                      this

                                                                                                      what

                                                                                                      I se

                                                                                                      t out

                                                                                                      to

                                                                                                      do

                                                                                                      bullFunbullOn-task

                                                                                                      bullNot funbullOn-task

                                                                                                      bullFunbullNot on-task

                                                                                                      bullNot funbullNot on-task

                                                                                                      Key Features of Video Games

                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                      Key Features of Video Games

                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                      Volkow et al 2004

                                                                                                      Increase salience

                                                                                                      Increase salience

                                                                                                      Quarterly QI review

                                                                                                      The post-mortem

                                                                                                      Your 1 Organizational Tool

                                                                                                      Your 1 Organizational Tool

                                                                                                      Yoga read

                                                                                                      Staff meeting

                                                                                                      Planningsession

                                                                                                      Phone calls

                                                                                                      billing

                                                                                                      Your 1 Organizational Tool

                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                      Your 1 Organizational Tool

                                                                                                      Learn French

                                                                                                      Stop smoking

                                                                                                      Be a better spouse

                                                                                                      The ldquoBig Fiverdquo

                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                      The ldquoBig Fiverdquo

                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                      The ldquoBig Fiverdquo

                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                      The ldquoBig Fiverdquo

                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                      The ldquoBig Fiverdquo

                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                      A CHALLENGEhellip

                                                                                                      wwwDrNowellcom

                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                      DavidNowellSeminars

                                                                                                      DavidNowell

                                                                                                      • Slide 1
                                                                                                      • hellipa challenge
                                                                                                      • Slide 3
                                                                                                      • Perspective of this workshophellip
                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                      • Slide 7
                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                      • Overview
                                                                                                      • This Dense Pudding
                                                                                                      • Sensory Processing Disorder
                                                                                                      • Slide 12
                                                                                                      • Slide 13
                                                                                                      • Developmental considerations
                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                      • Slide 17
                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                      • Slide 19
                                                                                                      • Strategies
                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                      • Slide 22
                                                                                                      • Slide 23
                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                      • Slide 25
                                                                                                      • Central Auditory Processing Disorder
                                                                                                      • Slide 27
                                                                                                      • Slide 28
                                                                                                      • Slide 29
                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                      • CAPD or ADHD
                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                      • Slide 35
                                                                                                      • Strategies (2)
                                                                                                      • (C)APD
                                                                                                      • Treatment for CAPD
                                                                                                      • Treatment for CAPD (2)
                                                                                                      • Self-assessment
                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                      • Slide 42
                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                      • (85 ndash X) x 365
                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                      • Core symptoms
                                                                                                      • Core symptoms (2)
                                                                                                      • hellipand the rest of the criteria
                                                                                                      • Slide 49
                                                                                                      • Functional impact of core symptoms
                                                                                                      • Functional impact of core symptoms (2)
                                                                                                      • Functional impact of core symptoms (3)
                                                                                                      • Slide 53
                                                                                                      • Functional impact of core symptoms (4)
                                                                                                      • Functional impact of core symptoms (5)
                                                                                                      • Functional impact of core symptoms (6)
                                                                                                      • Functional impact of core symptoms (7)
                                                                                                      • Functional impact of core symptoms (8)
                                                                                                      • Functional impact of core symptoms (9)
                                                                                                      • Subtypes of ADHD
                                                                                                      • Subtypes of ADHD (2)
                                                                                                      • Common comorbidities with ADHD
                                                                                                      • Slide 63
                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                      • ADHD and girls
                                                                                                      • Slide 66
                                                                                                      • Slide 67
                                                                                                      • ADHD and women
                                                                                                      • Slide 69
                                                                                                      • ADHD and women (2)
                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                      • The Executive Functions
                                                                                                      • The Executive Functions (2)
                                                                                                      • Slide 74
                                                                                                      • Slide 75
                                                                                                      • Appropriate expectations
                                                                                                      • Age-appropriate expectations
                                                                                                      • Age-appropriate expectations (2)
                                                                                                      • Age-appropriate expectations (3)
                                                                                                      • Age-appropriate expectations (4)
                                                                                                      • Age-appropriate expectations (5)
                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                      • Slide 84
                                                                                                      • Slide 85
                                                                                                      • Strategies (3)
                                                                                                      • Pharmacotherapy
                                                                                                      • Behavioral Supports
                                                                                                      • Slide 89
                                                                                                      • Slide 90
                                                                                                      • Slide 91
                                                                                                      • Slide 92
                                                                                                      • Slide 93
                                                                                                      • Slide 94
                                                                                                      • Slide 95
                                                                                                      • Slide 96
                                                                                                      • Slide 97
                                                                                                      • Slide 98
                                                                                                      • Slide 99
                                                                                                      • Slide 100
                                                                                                      • Slide 101
                                                                                                      • Slide 102
                                                                                                      • Slide 103
                                                                                                      • Slide 104
                                                                                                      • Slide 105
                                                                                                      • Slide 106
                                                                                                      • Slide 107
                                                                                                      • Slide 108
                                                                                                      • Slide 109
                                                                                                      • Slide 110
                                                                                                      • Time Out
                                                                                                      • Token economy
                                                                                                      • Slide 113
                                                                                                      • Slide 114
                                                                                                      • Slide 115
                                                                                                      • Intrinsic motivation
                                                                                                      • Slide 117
                                                                                                      • Slide 118
                                                                                                      • Slide 119
                                                                                                      • Metacognition
                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                      • What Does Dopamine Feel Like
                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                      • Slide 124
                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                      • Slide 128
                                                                                                      • Slide 129
                                                                                                      • Broaden and Build
                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                      • The reward-and-planning system
                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                      • The reward-and-planning system (2)
                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                      • Slide 141
                                                                                                      • Lend Me Your Brain
                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                      • Slide 146
                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                      • Slide 149
                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                      • Slide 152
                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                      • Slide 154
                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                      • Slide 157
                                                                                                      • Slide 158
                                                                                                      • Slide 159
                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                      • Slide 162
                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                      • Slide 164
                                                                                                      • Instant gratification vs executive gratification
                                                                                                      • Slide 166
                                                                                                      • Slide 167
                                                                                                      • Slide 168
                                                                                                      • Slide 169
                                                                                                      • Slide 170
                                                                                                      • Self-Talk Proficiency
                                                                                                      • Self-Talk Proficiency (2)
                                                                                                      • Self-Talk Proficiency (3)
                                                                                                      • Self-Talk Proficiency (4)
                                                                                                      • Match the Picture
                                                                                                      • Slide 176
                                                                                                      • Slide 177
                                                                                                      • Distraction Delay Training
                                                                                                      • Slide 179
                                                                                                      • Slide 180
                                                                                                      • Executive Estimates Training
                                                                                                      • Learning Time
                                                                                                      • Learning Time (2)
                                                                                                      • Learning Time (3)
                                                                                                      • Slide 185
                                                                                                      • Slide 186
                                                                                                      • Learning Time (4)
                                                                                                      • Asking two questionshellip
                                                                                                      • Slide 189
                                                                                                      • Slide 190
                                                                                                      • Key Features of Video Games
                                                                                                      • Key Features of Video Games (2)
                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                      • Slide 194
                                                                                                      • Slide 195
                                                                                                      • Slide 196
                                                                                                      • Slide 197
                                                                                                      • Slide 198
                                                                                                      • Slide 199
                                                                                                      • Slide 200
                                                                                                      • Slide 201
                                                                                                      • Quarterly QI review
                                                                                                      • The post-mortem
                                                                                                      • Slide 204
                                                                                                      • Slide 205
                                                                                                      • Slide 206
                                                                                                      • Slide 207
                                                                                                      • Slide 208
                                                                                                      • Slide 209
                                                                                                      • Slide 210
                                                                                                      • The ldquoBig Fiverdquo
                                                                                                      • Slide 212
                                                                                                      • Slide 213
                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                      • Slide 215
                                                                                                      • Slide 216
                                                                                                      • Slide 217
                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                      • A challengehellip
                                                                                                      • Slide 222

                                                                                                        ADHD and women

                                                                                                        ADHD and women

                                                                                                        More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                                        partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                                        disorganization

                                                                                                        Executive FunctioningAn Overarching Theme

                                                                                                        Sensory Processing Disorder Central Auditory Processing

                                                                                                        Disorder ADHD and Executive Dysfunction

                                                                                                        The Executive Functions

                                                                                                        Internalizing speech Previewing

                                                                                                        Prioritizing Tempo control Inhibition

                                                                                                        The Executive Functions

                                                                                                        Determining salience (whatrsquos in it for me)

                                                                                                        Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                                        Appropriate expectations

                                                                                                        Age-appropriate expectations

                                                                                                        Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                        Age-appropriate expectations

                                                                                                        K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                        3rd ndash 5th

                                                                                                        Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                        Age-appropriate expectations

                                                                                                        6th ndash 8th

                                                                                                        complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                        Age-appropriate expectations

                                                                                                        Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                        already made Take othersrsquo perspective

                                                                                                        Age-appropriate expectations

                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                        Inter-connectedness of systems Cortico-striatal system for example

                                                                                                        Strategies

                                                                                                        Pharmacotherapy

                                                                                                        X

                                                                                                        Behavioral Supports

                                                                                                        A B C

                                                                                                        A B C

                                                                                                        behavior

                                                                                                        A B C

                                                                                                        consequences

                                                                                                        A B C

                                                                                                        antecedent

                                                                                                        A B C

                                                                                                        A B C

                                                                                                        antecedent

                                                                                                        A B C

                                                                                                        antecedent

                                                                                                        easy hard

                                                                                                        A B C

                                                                                                        consequences

                                                                                                        R P

                                                                                                        +

                                                                                                        -

                                                                                                        R+ P+

                                                                                                        R- P-

                                                                                                        Time Out

                                                                                                        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                        Token economy

                                                                                                        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                        Intrinsic motivation

                                                                                                        A B C

                                                                                                        consequencesX

                                                                                                        A B C

                                                                                                        behavior

                                                                                                        Metacognition

                                                                                                        Metacognitive knowledge Metacognitive strategies

                                                                                                        ldquoLend Me Your Brainrdquo

                                                                                                        What Does Dopamine Feel Like

                                                                                                        The Physiology of Motivation and Reward

                                                                                                        Preferred States What Does Dopamine Feel Like

                                                                                                        1 Great experience2 Kodak moment3 The feeeeling

                                                                                                        David D Nowell PhD189 May Street

                                                                                                        Worcester Mass 01602DrNowellcom

                                                                                                        PREFERRED STATES INVENTORY

                                                                                                        wwwLulucom

                                                                                                        Identify 20 peak experiences For each peak experience identify the

                                                                                                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                        of that moment Name it Check the 20 peak moment-feelings for

                                                                                                        clusters groupings There will probably be 4 or 5

                                                                                                        PREFERRED STATES INVENTORY

                                                                                                        Find a word a label for each of the groupings

                                                                                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                        ldquovaluesrdquo ways that you really like to feel

                                                                                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                        PREFERRED STATES INVENTORY

                                                                                                        PREFERRED STATES INVENTORY

                                                                                                        Broaden and Build

                                                                                                        ldquoNeuroMalleabilityrdquo

                                                                                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                        The reward-and-planning system

                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                        The reward-and-planning system

                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                        Lend Me Your Brain

                                                                                                        Supporting Clients with Executive Dysfunction

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                        Too busy with current activity

                                                                                                        Field dependent

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Sequence problem-solve

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Block out distractions

                                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                        - E Goldberg

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Get the reward

                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                        Instant gratification vs

                                                                                                        executive gratification

                                                                                                        A B C

                                                                                                        behaviorx

                                                                                                        Self-Talk Proficiency

                                                                                                        Self-Talk Proficiency

                                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                        takerdquordquo

                                                                                                        Self-Talk Proficiency

                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                        Self-Talk Proficiency

                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                        thathelliprdquo

                                                                                                        Match the Picture

                                                                                                        Distraction Delay Training

                                                                                                        Executive Estimates Training

                                                                                                        X

                                                                                                        Learning Time

                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                        Learning Time

                                                                                                        Learning Time

                                                                                                        Learning Time

                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                        Asking two questionshellip

                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                        Am I having fun nowIs

                                                                                                        this

                                                                                                        what

                                                                                                        I se

                                                                                                        t out

                                                                                                        to

                                                                                                        do

                                                                                                        bullYesbullYes

                                                                                                        bullNobullYes

                                                                                                        bullYesbullNo

                                                                                                        bullNobullNo

                                                                                                        Am I having fun nowIs

                                                                                                        this

                                                                                                        what

                                                                                                        I se

                                                                                                        t out

                                                                                                        to

                                                                                                        do

                                                                                                        bullFunbullOn-task

                                                                                                        bullNot funbullOn-task

                                                                                                        bullFunbullNot on-task

                                                                                                        bullNot funbullNot on-task

                                                                                                        Key Features of Video Games

                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                        Key Features of Video Games

                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                        Volkow et al 2004

                                                                                                        Increase salience

                                                                                                        Increase salience

                                                                                                        Quarterly QI review

                                                                                                        The post-mortem

                                                                                                        Your 1 Organizational Tool

                                                                                                        Your 1 Organizational Tool

                                                                                                        Yoga read

                                                                                                        Staff meeting

                                                                                                        Planningsession

                                                                                                        Phone calls

                                                                                                        billing

                                                                                                        Your 1 Organizational Tool

                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                        Your 1 Organizational Tool

                                                                                                        Learn French

                                                                                                        Stop smoking

                                                                                                        Be a better spouse

                                                                                                        The ldquoBig Fiverdquo

                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                        The ldquoBig Fiverdquo

                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                        The ldquoBig Fiverdquo

                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                        The ldquoBig Fiverdquo

                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                        The ldquoBig Fiverdquo

                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                        A CHALLENGEhellip

                                                                                                        wwwDrNowellcom

                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                        DavidNowellSeminars

                                                                                                        DavidNowell

                                                                                                        • Slide 1
                                                                                                        • hellipa challenge
                                                                                                        • Slide 3
                                                                                                        • Perspective of this workshophellip
                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                        • Slide 7
                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                        • Overview
                                                                                                        • This Dense Pudding
                                                                                                        • Sensory Processing Disorder
                                                                                                        • Slide 12
                                                                                                        • Slide 13
                                                                                                        • Developmental considerations
                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                        • Slide 17
                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                        • Slide 19
                                                                                                        • Strategies
                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                        • Slide 22
                                                                                                        • Slide 23
                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                        • Slide 25
                                                                                                        • Central Auditory Processing Disorder
                                                                                                        • Slide 27
                                                                                                        • Slide 28
                                                                                                        • Slide 29
                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                        • CAPD or ADHD
                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                        • Slide 35
                                                                                                        • Strategies (2)
                                                                                                        • (C)APD
                                                                                                        • Treatment for CAPD
                                                                                                        • Treatment for CAPD (2)
                                                                                                        • Self-assessment
                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                        • Slide 42
                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                        • (85 ndash X) x 365
                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                        • Core symptoms
                                                                                                        • Core symptoms (2)
                                                                                                        • hellipand the rest of the criteria
                                                                                                        • Slide 49
                                                                                                        • Functional impact of core symptoms
                                                                                                        • Functional impact of core symptoms (2)
                                                                                                        • Functional impact of core symptoms (3)
                                                                                                        • Slide 53
                                                                                                        • Functional impact of core symptoms (4)
                                                                                                        • Functional impact of core symptoms (5)
                                                                                                        • Functional impact of core symptoms (6)
                                                                                                        • Functional impact of core symptoms (7)
                                                                                                        • Functional impact of core symptoms (8)
                                                                                                        • Functional impact of core symptoms (9)
                                                                                                        • Subtypes of ADHD
                                                                                                        • Subtypes of ADHD (2)
                                                                                                        • Common comorbidities with ADHD
                                                                                                        • Slide 63
                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                        • ADHD and girls
                                                                                                        • Slide 66
                                                                                                        • Slide 67
                                                                                                        • ADHD and women
                                                                                                        • Slide 69
                                                                                                        • ADHD and women (2)
                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                        • The Executive Functions
                                                                                                        • The Executive Functions (2)
                                                                                                        • Slide 74
                                                                                                        • Slide 75
                                                                                                        • Appropriate expectations
                                                                                                        • Age-appropriate expectations
                                                                                                        • Age-appropriate expectations (2)
                                                                                                        • Age-appropriate expectations (3)
                                                                                                        • Age-appropriate expectations (4)
                                                                                                        • Age-appropriate expectations (5)
                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                        • Slide 84
                                                                                                        • Slide 85
                                                                                                        • Strategies (3)
                                                                                                        • Pharmacotherapy
                                                                                                        • Behavioral Supports
                                                                                                        • Slide 89
                                                                                                        • Slide 90
                                                                                                        • Slide 91
                                                                                                        • Slide 92
                                                                                                        • Slide 93
                                                                                                        • Slide 94
                                                                                                        • Slide 95
                                                                                                        • Slide 96
                                                                                                        • Slide 97
                                                                                                        • Slide 98
                                                                                                        • Slide 99
                                                                                                        • Slide 100
                                                                                                        • Slide 101
                                                                                                        • Slide 102
                                                                                                        • Slide 103
                                                                                                        • Slide 104
                                                                                                        • Slide 105
                                                                                                        • Slide 106
                                                                                                        • Slide 107
                                                                                                        • Slide 108
                                                                                                        • Slide 109
                                                                                                        • Slide 110
                                                                                                        • Time Out
                                                                                                        • Token economy
                                                                                                        • Slide 113
                                                                                                        • Slide 114
                                                                                                        • Slide 115
                                                                                                        • Intrinsic motivation
                                                                                                        • Slide 117
                                                                                                        • Slide 118
                                                                                                        • Slide 119
                                                                                                        • Metacognition
                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                        • What Does Dopamine Feel Like
                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                        • Slide 124
                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                        • Slide 128
                                                                                                        • Slide 129
                                                                                                        • Broaden and Build
                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                        • The reward-and-planning system
                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                        • The reward-and-planning system (2)
                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                        • Slide 141
                                                                                                        • Lend Me Your Brain
                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                        • Slide 146
                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                        • Slide 149
                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                        • Slide 152
                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                        • Slide 154
                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                        • Slide 157
                                                                                                        • Slide 158
                                                                                                        • Slide 159
                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                        • Slide 162
                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                        • Slide 164
                                                                                                        • Instant gratification vs executive gratification
                                                                                                        • Slide 166
                                                                                                        • Slide 167
                                                                                                        • Slide 168
                                                                                                        • Slide 169
                                                                                                        • Slide 170
                                                                                                        • Self-Talk Proficiency
                                                                                                        • Self-Talk Proficiency (2)
                                                                                                        • Self-Talk Proficiency (3)
                                                                                                        • Self-Talk Proficiency (4)
                                                                                                        • Match the Picture
                                                                                                        • Slide 176
                                                                                                        • Slide 177
                                                                                                        • Distraction Delay Training
                                                                                                        • Slide 179
                                                                                                        • Slide 180
                                                                                                        • Executive Estimates Training
                                                                                                        • Learning Time
                                                                                                        • Learning Time (2)
                                                                                                        • Learning Time (3)
                                                                                                        • Slide 185
                                                                                                        • Slide 186
                                                                                                        • Learning Time (4)
                                                                                                        • Asking two questionshellip
                                                                                                        • Slide 189
                                                                                                        • Slide 190
                                                                                                        • Key Features of Video Games
                                                                                                        • Key Features of Video Games (2)
                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                        • Slide 194
                                                                                                        • Slide 195
                                                                                                        • Slide 196
                                                                                                        • Slide 197
                                                                                                        • Slide 198
                                                                                                        • Slide 199
                                                                                                        • Slide 200
                                                                                                        • Slide 201
                                                                                                        • Quarterly QI review
                                                                                                        • The post-mortem
                                                                                                        • Slide 204
                                                                                                        • Slide 205
                                                                                                        • Slide 206
                                                                                                        • Slide 207
                                                                                                        • Slide 208
                                                                                                        • Slide 209
                                                                                                        • Slide 210
                                                                                                        • The ldquoBig Fiverdquo
                                                                                                        • Slide 212
                                                                                                        • Slide 213
                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                        • Slide 215
                                                                                                        • Slide 216
                                                                                                        • Slide 217
                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                        • A challengehellip
                                                                                                        • Slide 222

                                                                                                          ADHD and women

                                                                                                          More tasks More diffuse More parental responsibility Less likely to have an ldquoexecutiverdquo

                                                                                                          partner Less likely to have assistants at work Less likely to focus on a narrow area More likely to feel shame about

                                                                                                          disorganization

                                                                                                          Executive FunctioningAn Overarching Theme

                                                                                                          Sensory Processing Disorder Central Auditory Processing

                                                                                                          Disorder ADHD and Executive Dysfunction

                                                                                                          The Executive Functions

                                                                                                          Internalizing speech Previewing

                                                                                                          Prioritizing Tempo control Inhibition

                                                                                                          The Executive Functions

                                                                                                          Determining salience (whatrsquos in it for me)

                                                                                                          Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                                          Appropriate expectations

                                                                                                          Age-appropriate expectations

                                                                                                          Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                          Age-appropriate expectations

                                                                                                          K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                          3rd ndash 5th

                                                                                                          Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                          Age-appropriate expectations

                                                                                                          6th ndash 8th

                                                                                                          complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                          Age-appropriate expectations

                                                                                                          Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                          already made Take othersrsquo perspective

                                                                                                          Age-appropriate expectations

                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                          Inter-connectedness of systems Cortico-striatal system for example

                                                                                                          Strategies

                                                                                                          Pharmacotherapy

                                                                                                          X

                                                                                                          Behavioral Supports

                                                                                                          A B C

                                                                                                          A B C

                                                                                                          behavior

                                                                                                          A B C

                                                                                                          consequences

                                                                                                          A B C

                                                                                                          antecedent

                                                                                                          A B C

                                                                                                          A B C

                                                                                                          antecedent

                                                                                                          A B C

                                                                                                          antecedent

                                                                                                          easy hard

                                                                                                          A B C

                                                                                                          consequences

                                                                                                          R P

                                                                                                          +

                                                                                                          -

                                                                                                          R+ P+

                                                                                                          R- P-

                                                                                                          Time Out

                                                                                                          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                          Token economy

                                                                                                          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                          Intrinsic motivation

                                                                                                          A B C

                                                                                                          consequencesX

                                                                                                          A B C

                                                                                                          behavior

                                                                                                          Metacognition

                                                                                                          Metacognitive knowledge Metacognitive strategies

                                                                                                          ldquoLend Me Your Brainrdquo

                                                                                                          What Does Dopamine Feel Like

                                                                                                          The Physiology of Motivation and Reward

                                                                                                          Preferred States What Does Dopamine Feel Like

                                                                                                          1 Great experience2 Kodak moment3 The feeeeling

                                                                                                          David D Nowell PhD189 May Street

                                                                                                          Worcester Mass 01602DrNowellcom

                                                                                                          PREFERRED STATES INVENTORY

                                                                                                          wwwLulucom

                                                                                                          Identify 20 peak experiences For each peak experience identify the

                                                                                                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                          of that moment Name it Check the 20 peak moment-feelings for

                                                                                                          clusters groupings There will probably be 4 or 5

                                                                                                          PREFERRED STATES INVENTORY

                                                                                                          Find a word a label for each of the groupings

                                                                                                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                          ldquovaluesrdquo ways that you really like to feel

                                                                                                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                          PREFERRED STATES INVENTORY

                                                                                                          PREFERRED STATES INVENTORY

                                                                                                          Broaden and Build

                                                                                                          ldquoNeuroMalleabilityrdquo

                                                                                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                          The reward-and-planning system

                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                          The reward-and-planning system

                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                          Lend Me Your Brain

                                                                                                          Supporting Clients with Executive Dysfunction

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                          Too busy with current activity

                                                                                                          Field dependent

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Sequence problem-solve

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Block out distractions

                                                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                          - E Goldberg

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Get the reward

                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                          Instant gratification vs

                                                                                                          executive gratification

                                                                                                          A B C

                                                                                                          behaviorx

                                                                                                          Self-Talk Proficiency

                                                                                                          Self-Talk Proficiency

                                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                          takerdquordquo

                                                                                                          Self-Talk Proficiency

                                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                                          Self-Talk Proficiency

                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                          thathelliprdquo

                                                                                                          Match the Picture

                                                                                                          Distraction Delay Training

                                                                                                          Executive Estimates Training

                                                                                                          X

                                                                                                          Learning Time

                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                          Learning Time

                                                                                                          Learning Time

                                                                                                          Learning Time

                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                          Asking two questionshellip

                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                          Am I having fun nowIs

                                                                                                          this

                                                                                                          what

                                                                                                          I se

                                                                                                          t out

                                                                                                          to

                                                                                                          do

                                                                                                          bullYesbullYes

                                                                                                          bullNobullYes

                                                                                                          bullYesbullNo

                                                                                                          bullNobullNo

                                                                                                          Am I having fun nowIs

                                                                                                          this

                                                                                                          what

                                                                                                          I se

                                                                                                          t out

                                                                                                          to

                                                                                                          do

                                                                                                          bullFunbullOn-task

                                                                                                          bullNot funbullOn-task

                                                                                                          bullFunbullNot on-task

                                                                                                          bullNot funbullNot on-task

                                                                                                          Key Features of Video Games

                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                          Key Features of Video Games

                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                          Volkow et al 2004

                                                                                                          Increase salience

                                                                                                          Increase salience

                                                                                                          Quarterly QI review

                                                                                                          The post-mortem

                                                                                                          Your 1 Organizational Tool

                                                                                                          Your 1 Organizational Tool

                                                                                                          Yoga read

                                                                                                          Staff meeting

                                                                                                          Planningsession

                                                                                                          Phone calls

                                                                                                          billing

                                                                                                          Your 1 Organizational Tool

                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                          Your 1 Organizational Tool

                                                                                                          Learn French

                                                                                                          Stop smoking

                                                                                                          Be a better spouse

                                                                                                          The ldquoBig Fiverdquo

                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                          The ldquoBig Fiverdquo

                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                          The ldquoBig Fiverdquo

                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                          The ldquoBig Fiverdquo

                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                          The ldquoBig Fiverdquo

                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                          A CHALLENGEhellip

                                                                                                          wwwDrNowellcom

                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                          DavidNowellSeminars

                                                                                                          DavidNowell

                                                                                                          • Slide 1
                                                                                                          • hellipa challenge
                                                                                                          • Slide 3
                                                                                                          • Perspective of this workshophellip
                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                          • Slide 7
                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                          • Overview
                                                                                                          • This Dense Pudding
                                                                                                          • Sensory Processing Disorder
                                                                                                          • Slide 12
                                                                                                          • Slide 13
                                                                                                          • Developmental considerations
                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                          • Slide 17
                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                          • Slide 19
                                                                                                          • Strategies
                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                          • Slide 22
                                                                                                          • Slide 23
                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                          • Slide 25
                                                                                                          • Central Auditory Processing Disorder
                                                                                                          • Slide 27
                                                                                                          • Slide 28
                                                                                                          • Slide 29
                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                          • CAPD or ADHD
                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                          • Slide 35
                                                                                                          • Strategies (2)
                                                                                                          • (C)APD
                                                                                                          • Treatment for CAPD
                                                                                                          • Treatment for CAPD (2)
                                                                                                          • Self-assessment
                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                          • Slide 42
                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                          • (85 ndash X) x 365
                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                          • Core symptoms
                                                                                                          • Core symptoms (2)
                                                                                                          • hellipand the rest of the criteria
                                                                                                          • Slide 49
                                                                                                          • Functional impact of core symptoms
                                                                                                          • Functional impact of core symptoms (2)
                                                                                                          • Functional impact of core symptoms (3)
                                                                                                          • Slide 53
                                                                                                          • Functional impact of core symptoms (4)
                                                                                                          • Functional impact of core symptoms (5)
                                                                                                          • Functional impact of core symptoms (6)
                                                                                                          • Functional impact of core symptoms (7)
                                                                                                          • Functional impact of core symptoms (8)
                                                                                                          • Functional impact of core symptoms (9)
                                                                                                          • Subtypes of ADHD
                                                                                                          • Subtypes of ADHD (2)
                                                                                                          • Common comorbidities with ADHD
                                                                                                          • Slide 63
                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                          • ADHD and girls
                                                                                                          • Slide 66
                                                                                                          • Slide 67
                                                                                                          • ADHD and women
                                                                                                          • Slide 69
                                                                                                          • ADHD and women (2)
                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                          • The Executive Functions
                                                                                                          • The Executive Functions (2)
                                                                                                          • Slide 74
                                                                                                          • Slide 75
                                                                                                          • Appropriate expectations
                                                                                                          • Age-appropriate expectations
                                                                                                          • Age-appropriate expectations (2)
                                                                                                          • Age-appropriate expectations (3)
                                                                                                          • Age-appropriate expectations (4)
                                                                                                          • Age-appropriate expectations (5)
                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                          • Slide 84
                                                                                                          • Slide 85
                                                                                                          • Strategies (3)
                                                                                                          • Pharmacotherapy
                                                                                                          • Behavioral Supports
                                                                                                          • Slide 89
                                                                                                          • Slide 90
                                                                                                          • Slide 91
                                                                                                          • Slide 92
                                                                                                          • Slide 93
                                                                                                          • Slide 94
                                                                                                          • Slide 95
                                                                                                          • Slide 96
                                                                                                          • Slide 97
                                                                                                          • Slide 98
                                                                                                          • Slide 99
                                                                                                          • Slide 100
                                                                                                          • Slide 101
                                                                                                          • Slide 102
                                                                                                          • Slide 103
                                                                                                          • Slide 104
                                                                                                          • Slide 105
                                                                                                          • Slide 106
                                                                                                          • Slide 107
                                                                                                          • Slide 108
                                                                                                          • Slide 109
                                                                                                          • Slide 110
                                                                                                          • Time Out
                                                                                                          • Token economy
                                                                                                          • Slide 113
                                                                                                          • Slide 114
                                                                                                          • Slide 115
                                                                                                          • Intrinsic motivation
                                                                                                          • Slide 117
                                                                                                          • Slide 118
                                                                                                          • Slide 119
                                                                                                          • Metacognition
                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                          • What Does Dopamine Feel Like
                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                          • Slide 124
                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                          • Slide 128
                                                                                                          • Slide 129
                                                                                                          • Broaden and Build
                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                          • The reward-and-planning system
                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                          • The reward-and-planning system (2)
                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                          • Slide 141
                                                                                                          • Lend Me Your Brain
                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                          • Slide 146
                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                          • Slide 149
                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                          • Slide 152
                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                          • Slide 154
                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                          • Slide 157
                                                                                                          • Slide 158
                                                                                                          • Slide 159
                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                          • Slide 162
                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                          • Slide 164
                                                                                                          • Instant gratification vs executive gratification
                                                                                                          • Slide 166
                                                                                                          • Slide 167
                                                                                                          • Slide 168
                                                                                                          • Slide 169
                                                                                                          • Slide 170
                                                                                                          • Self-Talk Proficiency
                                                                                                          • Self-Talk Proficiency (2)
                                                                                                          • Self-Talk Proficiency (3)
                                                                                                          • Self-Talk Proficiency (4)
                                                                                                          • Match the Picture
                                                                                                          • Slide 176
                                                                                                          • Slide 177
                                                                                                          • Distraction Delay Training
                                                                                                          • Slide 179
                                                                                                          • Slide 180
                                                                                                          • Executive Estimates Training
                                                                                                          • Learning Time
                                                                                                          • Learning Time (2)
                                                                                                          • Learning Time (3)
                                                                                                          • Slide 185
                                                                                                          • Slide 186
                                                                                                          • Learning Time (4)
                                                                                                          • Asking two questionshellip
                                                                                                          • Slide 189
                                                                                                          • Slide 190
                                                                                                          • Key Features of Video Games
                                                                                                          • Key Features of Video Games (2)
                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                          • Slide 194
                                                                                                          • Slide 195
                                                                                                          • Slide 196
                                                                                                          • Slide 197
                                                                                                          • Slide 198
                                                                                                          • Slide 199
                                                                                                          • Slide 200
                                                                                                          • Slide 201
                                                                                                          • Quarterly QI review
                                                                                                          • The post-mortem
                                                                                                          • Slide 204
                                                                                                          • Slide 205
                                                                                                          • Slide 206
                                                                                                          • Slide 207
                                                                                                          • Slide 208
                                                                                                          • Slide 209
                                                                                                          • Slide 210
                                                                                                          • The ldquoBig Fiverdquo
                                                                                                          • Slide 212
                                                                                                          • Slide 213
                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                          • Slide 215
                                                                                                          • Slide 216
                                                                                                          • Slide 217
                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                          • A challengehellip
                                                                                                          • Slide 222

                                                                                                            Executive FunctioningAn Overarching Theme

                                                                                                            Sensory Processing Disorder Central Auditory Processing

                                                                                                            Disorder ADHD and Executive Dysfunction

                                                                                                            The Executive Functions

                                                                                                            Internalizing speech Previewing

                                                                                                            Prioritizing Tempo control Inhibition

                                                                                                            The Executive Functions

                                                                                                            Determining salience (whatrsquos in it for me)

                                                                                                            Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                                            Appropriate expectations

                                                                                                            Age-appropriate expectations

                                                                                                            Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                            Age-appropriate expectations

                                                                                                            K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                            3rd ndash 5th

                                                                                                            Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                            Age-appropriate expectations

                                                                                                            6th ndash 8th

                                                                                                            complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                            Age-appropriate expectations

                                                                                                            Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                            already made Take othersrsquo perspective

                                                                                                            Age-appropriate expectations

                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                            Inter-connectedness of systems Cortico-striatal system for example

                                                                                                            Strategies

                                                                                                            Pharmacotherapy

                                                                                                            X

                                                                                                            Behavioral Supports

                                                                                                            A B C

                                                                                                            A B C

                                                                                                            behavior

                                                                                                            A B C

                                                                                                            consequences

                                                                                                            A B C

                                                                                                            antecedent

                                                                                                            A B C

                                                                                                            A B C

                                                                                                            antecedent

                                                                                                            A B C

                                                                                                            antecedent

                                                                                                            easy hard

                                                                                                            A B C

                                                                                                            consequences

                                                                                                            R P

                                                                                                            +

                                                                                                            -

                                                                                                            R+ P+

                                                                                                            R- P-

                                                                                                            Time Out

                                                                                                            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                            Token economy

                                                                                                            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                            Intrinsic motivation

                                                                                                            A B C

                                                                                                            consequencesX

                                                                                                            A B C

                                                                                                            behavior

                                                                                                            Metacognition

                                                                                                            Metacognitive knowledge Metacognitive strategies

                                                                                                            ldquoLend Me Your Brainrdquo

                                                                                                            What Does Dopamine Feel Like

                                                                                                            The Physiology of Motivation and Reward

                                                                                                            Preferred States What Does Dopamine Feel Like

                                                                                                            1 Great experience2 Kodak moment3 The feeeeling

                                                                                                            David D Nowell PhD189 May Street

                                                                                                            Worcester Mass 01602DrNowellcom

                                                                                                            PREFERRED STATES INVENTORY

                                                                                                            wwwLulucom

                                                                                                            Identify 20 peak experiences For each peak experience identify the

                                                                                                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                            of that moment Name it Check the 20 peak moment-feelings for

                                                                                                            clusters groupings There will probably be 4 or 5

                                                                                                            PREFERRED STATES INVENTORY

                                                                                                            Find a word a label for each of the groupings

                                                                                                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                            ldquovaluesrdquo ways that you really like to feel

                                                                                                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                            PREFERRED STATES INVENTORY

                                                                                                            PREFERRED STATES INVENTORY

                                                                                                            Broaden and Build

                                                                                                            ldquoNeuroMalleabilityrdquo

                                                                                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                            The reward-and-planning system

                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                            The reward-and-planning system

                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                            Lend Me Your Brain

                                                                                                            Supporting Clients with Executive Dysfunction

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                            Too busy with current activity

                                                                                                            Field dependent

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Sequence problem-solve

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Block out distractions

                                                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                            - E Goldberg

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Get the reward

                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                            Instant gratification vs

                                                                                                            executive gratification

                                                                                                            A B C

                                                                                                            behaviorx

                                                                                                            Self-Talk Proficiency

                                                                                                            Self-Talk Proficiency

                                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                            takerdquordquo

                                                                                                            Self-Talk Proficiency

                                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                                            Self-Talk Proficiency

                                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                                            thathelliprdquo

                                                                                                            Match the Picture

                                                                                                            Distraction Delay Training

                                                                                                            Executive Estimates Training

                                                                                                            X

                                                                                                            Learning Time

                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                            Learning Time

                                                                                                            Learning Time

                                                                                                            Learning Time

                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                            Asking two questionshellip

                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                            Am I having fun nowIs

                                                                                                            this

                                                                                                            what

                                                                                                            I se

                                                                                                            t out

                                                                                                            to

                                                                                                            do

                                                                                                            bullYesbullYes

                                                                                                            bullNobullYes

                                                                                                            bullYesbullNo

                                                                                                            bullNobullNo

                                                                                                            Am I having fun nowIs

                                                                                                            this

                                                                                                            what

                                                                                                            I se

                                                                                                            t out

                                                                                                            to

                                                                                                            do

                                                                                                            bullFunbullOn-task

                                                                                                            bullNot funbullOn-task

                                                                                                            bullFunbullNot on-task

                                                                                                            bullNot funbullNot on-task

                                                                                                            Key Features of Video Games

                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                            Key Features of Video Games

                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                            Volkow et al 2004

                                                                                                            Increase salience

                                                                                                            Increase salience

                                                                                                            Quarterly QI review

                                                                                                            The post-mortem

                                                                                                            Your 1 Organizational Tool

                                                                                                            Your 1 Organizational Tool

                                                                                                            Yoga read

                                                                                                            Staff meeting

                                                                                                            Planningsession

                                                                                                            Phone calls

                                                                                                            billing

                                                                                                            Your 1 Organizational Tool

                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                            Your 1 Organizational Tool

                                                                                                            Learn French

                                                                                                            Stop smoking

                                                                                                            Be a better spouse

                                                                                                            The ldquoBig Fiverdquo

                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                            The ldquoBig Fiverdquo

                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                            The ldquoBig Fiverdquo

                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                            The ldquoBig Fiverdquo

                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                            The ldquoBig Fiverdquo

                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                            A CHALLENGEhellip

                                                                                                            wwwDrNowellcom

                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                            DavidNowellSeminars

                                                                                                            DavidNowell

                                                                                                            • Slide 1
                                                                                                            • hellipa challenge
                                                                                                            • Slide 3
                                                                                                            • Perspective of this workshophellip
                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                            • Slide 7
                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                            • Overview
                                                                                                            • This Dense Pudding
                                                                                                            • Sensory Processing Disorder
                                                                                                            • Slide 12
                                                                                                            • Slide 13
                                                                                                            • Developmental considerations
                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                            • Slide 17
                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                            • Slide 19
                                                                                                            • Strategies
                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                            • Slide 22
                                                                                                            • Slide 23
                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                            • Slide 25
                                                                                                            • Central Auditory Processing Disorder
                                                                                                            • Slide 27
                                                                                                            • Slide 28
                                                                                                            • Slide 29
                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                            • CAPD or ADHD
                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                            • Slide 35
                                                                                                            • Strategies (2)
                                                                                                            • (C)APD
                                                                                                            • Treatment for CAPD
                                                                                                            • Treatment for CAPD (2)
                                                                                                            • Self-assessment
                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                            • Slide 42
                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                            • (85 ndash X) x 365
                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                            • Core symptoms
                                                                                                            • Core symptoms (2)
                                                                                                            • hellipand the rest of the criteria
                                                                                                            • Slide 49
                                                                                                            • Functional impact of core symptoms
                                                                                                            • Functional impact of core symptoms (2)
                                                                                                            • Functional impact of core symptoms (3)
                                                                                                            • Slide 53
                                                                                                            • Functional impact of core symptoms (4)
                                                                                                            • Functional impact of core symptoms (5)
                                                                                                            • Functional impact of core symptoms (6)
                                                                                                            • Functional impact of core symptoms (7)
                                                                                                            • Functional impact of core symptoms (8)
                                                                                                            • Functional impact of core symptoms (9)
                                                                                                            • Subtypes of ADHD
                                                                                                            • Subtypes of ADHD (2)
                                                                                                            • Common comorbidities with ADHD
                                                                                                            • Slide 63
                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                            • ADHD and girls
                                                                                                            • Slide 66
                                                                                                            • Slide 67
                                                                                                            • ADHD and women
                                                                                                            • Slide 69
                                                                                                            • ADHD and women (2)
                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                            • The Executive Functions
                                                                                                            • The Executive Functions (2)
                                                                                                            • Slide 74
                                                                                                            • Slide 75
                                                                                                            • Appropriate expectations
                                                                                                            • Age-appropriate expectations
                                                                                                            • Age-appropriate expectations (2)
                                                                                                            • Age-appropriate expectations (3)
                                                                                                            • Age-appropriate expectations (4)
                                                                                                            • Age-appropriate expectations (5)
                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                            • Slide 84
                                                                                                            • Slide 85
                                                                                                            • Strategies (3)
                                                                                                            • Pharmacotherapy
                                                                                                            • Behavioral Supports
                                                                                                            • Slide 89
                                                                                                            • Slide 90
                                                                                                            • Slide 91
                                                                                                            • Slide 92
                                                                                                            • Slide 93
                                                                                                            • Slide 94
                                                                                                            • Slide 95
                                                                                                            • Slide 96
                                                                                                            • Slide 97
                                                                                                            • Slide 98
                                                                                                            • Slide 99
                                                                                                            • Slide 100
                                                                                                            • Slide 101
                                                                                                            • Slide 102
                                                                                                            • Slide 103
                                                                                                            • Slide 104
                                                                                                            • Slide 105
                                                                                                            • Slide 106
                                                                                                            • Slide 107
                                                                                                            • Slide 108
                                                                                                            • Slide 109
                                                                                                            • Slide 110
                                                                                                            • Time Out
                                                                                                            • Token economy
                                                                                                            • Slide 113
                                                                                                            • Slide 114
                                                                                                            • Slide 115
                                                                                                            • Intrinsic motivation
                                                                                                            • Slide 117
                                                                                                            • Slide 118
                                                                                                            • Slide 119
                                                                                                            • Metacognition
                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                            • What Does Dopamine Feel Like
                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                            • Slide 124
                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                            • Slide 128
                                                                                                            • Slide 129
                                                                                                            • Broaden and Build
                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                            • The reward-and-planning system
                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                            • The reward-and-planning system (2)
                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                            • Slide 141
                                                                                                            • Lend Me Your Brain
                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                            • Slide 146
                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                            • Slide 149
                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                            • Slide 152
                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                            • Slide 154
                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                            • Slide 157
                                                                                                            • Slide 158
                                                                                                            • Slide 159
                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                            • Slide 162
                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                            • Slide 164
                                                                                                            • Instant gratification vs executive gratification
                                                                                                            • Slide 166
                                                                                                            • Slide 167
                                                                                                            • Slide 168
                                                                                                            • Slide 169
                                                                                                            • Slide 170
                                                                                                            • Self-Talk Proficiency
                                                                                                            • Self-Talk Proficiency (2)
                                                                                                            • Self-Talk Proficiency (3)
                                                                                                            • Self-Talk Proficiency (4)
                                                                                                            • Match the Picture
                                                                                                            • Slide 176
                                                                                                            • Slide 177
                                                                                                            • Distraction Delay Training
                                                                                                            • Slide 179
                                                                                                            • Slide 180
                                                                                                            • Executive Estimates Training
                                                                                                            • Learning Time
                                                                                                            • Learning Time (2)
                                                                                                            • Learning Time (3)
                                                                                                            • Slide 185
                                                                                                            • Slide 186
                                                                                                            • Learning Time (4)
                                                                                                            • Asking two questionshellip
                                                                                                            • Slide 189
                                                                                                            • Slide 190
                                                                                                            • Key Features of Video Games
                                                                                                            • Key Features of Video Games (2)
                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                            • Slide 194
                                                                                                            • Slide 195
                                                                                                            • Slide 196
                                                                                                            • Slide 197
                                                                                                            • Slide 198
                                                                                                            • Slide 199
                                                                                                            • Slide 200
                                                                                                            • Slide 201
                                                                                                            • Quarterly QI review
                                                                                                            • The post-mortem
                                                                                                            • Slide 204
                                                                                                            • Slide 205
                                                                                                            • Slide 206
                                                                                                            • Slide 207
                                                                                                            • Slide 208
                                                                                                            • Slide 209
                                                                                                            • Slide 210
                                                                                                            • The ldquoBig Fiverdquo
                                                                                                            • Slide 212
                                                                                                            • Slide 213
                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                            • Slide 215
                                                                                                            • Slide 216
                                                                                                            • Slide 217
                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                            • A challengehellip
                                                                                                            • Slide 222

                                                                                                              The Executive Functions

                                                                                                              Internalizing speech Previewing

                                                                                                              Prioritizing Tempo control Inhibition

                                                                                                              The Executive Functions

                                                                                                              Determining salience (whatrsquos in it for me)

                                                                                                              Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                                              Appropriate expectations

                                                                                                              Age-appropriate expectations

                                                                                                              Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                              Age-appropriate expectations

                                                                                                              K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                              3rd ndash 5th

                                                                                                              Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                              Age-appropriate expectations

                                                                                                              6th ndash 8th

                                                                                                              complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                              Age-appropriate expectations

                                                                                                              Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                              already made Take othersrsquo perspective

                                                                                                              Age-appropriate expectations

                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                              Inter-connectedness of systems Cortico-striatal system for example

                                                                                                              Strategies

                                                                                                              Pharmacotherapy

                                                                                                              X

                                                                                                              Behavioral Supports

                                                                                                              A B C

                                                                                                              A B C

                                                                                                              behavior

                                                                                                              A B C

                                                                                                              consequences

                                                                                                              A B C

                                                                                                              antecedent

                                                                                                              A B C

                                                                                                              A B C

                                                                                                              antecedent

                                                                                                              A B C

                                                                                                              antecedent

                                                                                                              easy hard

                                                                                                              A B C

                                                                                                              consequences

                                                                                                              R P

                                                                                                              +

                                                                                                              -

                                                                                                              R+ P+

                                                                                                              R- P-

                                                                                                              Time Out

                                                                                                              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                              Token economy

                                                                                                              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                              Intrinsic motivation

                                                                                                              A B C

                                                                                                              consequencesX

                                                                                                              A B C

                                                                                                              behavior

                                                                                                              Metacognition

                                                                                                              Metacognitive knowledge Metacognitive strategies

                                                                                                              ldquoLend Me Your Brainrdquo

                                                                                                              What Does Dopamine Feel Like

                                                                                                              The Physiology of Motivation and Reward

                                                                                                              Preferred States What Does Dopamine Feel Like

                                                                                                              1 Great experience2 Kodak moment3 The feeeeling

                                                                                                              David D Nowell PhD189 May Street

                                                                                                              Worcester Mass 01602DrNowellcom

                                                                                                              PREFERRED STATES INVENTORY

                                                                                                              wwwLulucom

                                                                                                              Identify 20 peak experiences For each peak experience identify the

                                                                                                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                              of that moment Name it Check the 20 peak moment-feelings for

                                                                                                              clusters groupings There will probably be 4 or 5

                                                                                                              PREFERRED STATES INVENTORY

                                                                                                              Find a word a label for each of the groupings

                                                                                                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                              ldquovaluesrdquo ways that you really like to feel

                                                                                                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                              PREFERRED STATES INVENTORY

                                                                                                              PREFERRED STATES INVENTORY

                                                                                                              Broaden and Build

                                                                                                              ldquoNeuroMalleabilityrdquo

                                                                                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                              The reward-and-planning system

                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                              The reward-and-planning system

                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                              Lend Me Your Brain

                                                                                                              Supporting Clients with Executive Dysfunction

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                              Too busy with current activity

                                                                                                              Field dependent

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Sequence problem-solve

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Block out distractions

                                                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                              - E Goldberg

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Get the reward

                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                              Instant gratification vs

                                                                                                              executive gratification

                                                                                                              A B C

                                                                                                              behaviorx

                                                                                                              Self-Talk Proficiency

                                                                                                              Self-Talk Proficiency

                                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                              takerdquordquo

                                                                                                              Self-Talk Proficiency

                                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                                              Self-Talk Proficiency

                                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                                              thathelliprdquo

                                                                                                              Match the Picture

                                                                                                              Distraction Delay Training

                                                                                                              Executive Estimates Training

                                                                                                              X

                                                                                                              Learning Time

                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                              Learning Time

                                                                                                              Learning Time

                                                                                                              Learning Time

                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                              Asking two questionshellip

                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                              Am I having fun nowIs

                                                                                                              this

                                                                                                              what

                                                                                                              I se

                                                                                                              t out

                                                                                                              to

                                                                                                              do

                                                                                                              bullYesbullYes

                                                                                                              bullNobullYes

                                                                                                              bullYesbullNo

                                                                                                              bullNobullNo

                                                                                                              Am I having fun nowIs

                                                                                                              this

                                                                                                              what

                                                                                                              I se

                                                                                                              t out

                                                                                                              to

                                                                                                              do

                                                                                                              bullFunbullOn-task

                                                                                                              bullNot funbullOn-task

                                                                                                              bullFunbullNot on-task

                                                                                                              bullNot funbullNot on-task

                                                                                                              Key Features of Video Games

                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                              Key Features of Video Games

                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                              Volkow et al 2004

                                                                                                              Increase salience

                                                                                                              Increase salience

                                                                                                              Quarterly QI review

                                                                                                              The post-mortem

                                                                                                              Your 1 Organizational Tool

                                                                                                              Your 1 Organizational Tool

                                                                                                              Yoga read

                                                                                                              Staff meeting

                                                                                                              Planningsession

                                                                                                              Phone calls

                                                                                                              billing

                                                                                                              Your 1 Organizational Tool

                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                              Your 1 Organizational Tool

                                                                                                              Learn French

                                                                                                              Stop smoking

                                                                                                              Be a better spouse

                                                                                                              The ldquoBig Fiverdquo

                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                              The ldquoBig Fiverdquo

                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                              The ldquoBig Fiverdquo

                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                              The ldquoBig Fiverdquo

                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                              The ldquoBig Fiverdquo

                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                              A CHALLENGEhellip

                                                                                                              wwwDrNowellcom

                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                              DavidNowellSeminars

                                                                                                              DavidNowell

                                                                                                              • Slide 1
                                                                                                              • hellipa challenge
                                                                                                              • Slide 3
                                                                                                              • Perspective of this workshophellip
                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                              • Slide 7
                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                              • Overview
                                                                                                              • This Dense Pudding
                                                                                                              • Sensory Processing Disorder
                                                                                                              • Slide 12
                                                                                                              • Slide 13
                                                                                                              • Developmental considerations
                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                              • Slide 17
                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                              • Slide 19
                                                                                                              • Strategies
                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                              • Slide 22
                                                                                                              • Slide 23
                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                              • Slide 25
                                                                                                              • Central Auditory Processing Disorder
                                                                                                              • Slide 27
                                                                                                              • Slide 28
                                                                                                              • Slide 29
                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                              • CAPD or ADHD
                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                              • Slide 35
                                                                                                              • Strategies (2)
                                                                                                              • (C)APD
                                                                                                              • Treatment for CAPD
                                                                                                              • Treatment for CAPD (2)
                                                                                                              • Self-assessment
                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                              • Slide 42
                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                              • (85 ndash X) x 365
                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                              • Core symptoms
                                                                                                              • Core symptoms (2)
                                                                                                              • hellipand the rest of the criteria
                                                                                                              • Slide 49
                                                                                                              • Functional impact of core symptoms
                                                                                                              • Functional impact of core symptoms (2)
                                                                                                              • Functional impact of core symptoms (3)
                                                                                                              • Slide 53
                                                                                                              • Functional impact of core symptoms (4)
                                                                                                              • Functional impact of core symptoms (5)
                                                                                                              • Functional impact of core symptoms (6)
                                                                                                              • Functional impact of core symptoms (7)
                                                                                                              • Functional impact of core symptoms (8)
                                                                                                              • Functional impact of core symptoms (9)
                                                                                                              • Subtypes of ADHD
                                                                                                              • Subtypes of ADHD (2)
                                                                                                              • Common comorbidities with ADHD
                                                                                                              • Slide 63
                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                              • ADHD and girls
                                                                                                              • Slide 66
                                                                                                              • Slide 67
                                                                                                              • ADHD and women
                                                                                                              • Slide 69
                                                                                                              • ADHD and women (2)
                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                              • The Executive Functions
                                                                                                              • The Executive Functions (2)
                                                                                                              • Slide 74
                                                                                                              • Slide 75
                                                                                                              • Appropriate expectations
                                                                                                              • Age-appropriate expectations
                                                                                                              • Age-appropriate expectations (2)
                                                                                                              • Age-appropriate expectations (3)
                                                                                                              • Age-appropriate expectations (4)
                                                                                                              • Age-appropriate expectations (5)
                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                              • Slide 84
                                                                                                              • Slide 85
                                                                                                              • Strategies (3)
                                                                                                              • Pharmacotherapy
                                                                                                              • Behavioral Supports
                                                                                                              • Slide 89
                                                                                                              • Slide 90
                                                                                                              • Slide 91
                                                                                                              • Slide 92
                                                                                                              • Slide 93
                                                                                                              • Slide 94
                                                                                                              • Slide 95
                                                                                                              • Slide 96
                                                                                                              • Slide 97
                                                                                                              • Slide 98
                                                                                                              • Slide 99
                                                                                                              • Slide 100
                                                                                                              • Slide 101
                                                                                                              • Slide 102
                                                                                                              • Slide 103
                                                                                                              • Slide 104
                                                                                                              • Slide 105
                                                                                                              • Slide 106
                                                                                                              • Slide 107
                                                                                                              • Slide 108
                                                                                                              • Slide 109
                                                                                                              • Slide 110
                                                                                                              • Time Out
                                                                                                              • Token economy
                                                                                                              • Slide 113
                                                                                                              • Slide 114
                                                                                                              • Slide 115
                                                                                                              • Intrinsic motivation
                                                                                                              • Slide 117
                                                                                                              • Slide 118
                                                                                                              • Slide 119
                                                                                                              • Metacognition
                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                              • What Does Dopamine Feel Like
                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                              • Slide 124
                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                              • Slide 128
                                                                                                              • Slide 129
                                                                                                              • Broaden and Build
                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                              • The reward-and-planning system
                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                              • The reward-and-planning system (2)
                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                              • Slide 141
                                                                                                              • Lend Me Your Brain
                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                              • Slide 146
                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                              • Slide 149
                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                              • Slide 152
                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                              • Slide 154
                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                              • Slide 157
                                                                                                              • Slide 158
                                                                                                              • Slide 159
                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                              • Slide 162
                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                              • Slide 164
                                                                                                              • Instant gratification vs executive gratification
                                                                                                              • Slide 166
                                                                                                              • Slide 167
                                                                                                              • Slide 168
                                                                                                              • Slide 169
                                                                                                              • Slide 170
                                                                                                              • Self-Talk Proficiency
                                                                                                              • Self-Talk Proficiency (2)
                                                                                                              • Self-Talk Proficiency (3)
                                                                                                              • Self-Talk Proficiency (4)
                                                                                                              • Match the Picture
                                                                                                              • Slide 176
                                                                                                              • Slide 177
                                                                                                              • Distraction Delay Training
                                                                                                              • Slide 179
                                                                                                              • Slide 180
                                                                                                              • Executive Estimates Training
                                                                                                              • Learning Time
                                                                                                              • Learning Time (2)
                                                                                                              • Learning Time (3)
                                                                                                              • Slide 185
                                                                                                              • Slide 186
                                                                                                              • Learning Time (4)
                                                                                                              • Asking two questionshellip
                                                                                                              • Slide 189
                                                                                                              • Slide 190
                                                                                                              • Key Features of Video Games
                                                                                                              • Key Features of Video Games (2)
                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                              • Slide 194
                                                                                                              • Slide 195
                                                                                                              • Slide 196
                                                                                                              • Slide 197
                                                                                                              • Slide 198
                                                                                                              • Slide 199
                                                                                                              • Slide 200
                                                                                                              • Slide 201
                                                                                                              • Quarterly QI review
                                                                                                              • The post-mortem
                                                                                                              • Slide 204
                                                                                                              • Slide 205
                                                                                                              • Slide 206
                                                                                                              • Slide 207
                                                                                                              • Slide 208
                                                                                                              • Slide 209
                                                                                                              • Slide 210
                                                                                                              • The ldquoBig Fiverdquo
                                                                                                              • Slide 212
                                                                                                              • Slide 213
                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                              • Slide 215
                                                                                                              • Slide 216
                                                                                                              • Slide 217
                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                              • A challengehellip
                                                                                                              • Slide 222

                                                                                                                The Executive Functions

                                                                                                                Determining salience (whatrsquos in it for me)

                                                                                                                Blocking out distractions Self-monitoring and correcting Certain aspects of memory learning

                                                                                                                Appropriate expectations

                                                                                                                Age-appropriate expectations

                                                                                                                Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                                Age-appropriate expectations

                                                                                                                K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                                3rd ndash 5th

                                                                                                                Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                                Age-appropriate expectations

                                                                                                                6th ndash 8th

                                                                                                                complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                                Age-appropriate expectations

                                                                                                                Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                                already made Take othersrsquo perspective

                                                                                                                Age-appropriate expectations

                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                Strategies

                                                                                                                Pharmacotherapy

                                                                                                                X

                                                                                                                Behavioral Supports

                                                                                                                A B C

                                                                                                                A B C

                                                                                                                behavior

                                                                                                                A B C

                                                                                                                consequences

                                                                                                                A B C

                                                                                                                antecedent

                                                                                                                A B C

                                                                                                                A B C

                                                                                                                antecedent

                                                                                                                A B C

                                                                                                                antecedent

                                                                                                                easy hard

                                                                                                                A B C

                                                                                                                consequences

                                                                                                                R P

                                                                                                                +

                                                                                                                -

                                                                                                                R+ P+

                                                                                                                R- P-

                                                                                                                Time Out

                                                                                                                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                Token economy

                                                                                                                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                Intrinsic motivation

                                                                                                                A B C

                                                                                                                consequencesX

                                                                                                                A B C

                                                                                                                behavior

                                                                                                                Metacognition

                                                                                                                Metacognitive knowledge Metacognitive strategies

                                                                                                                ldquoLend Me Your Brainrdquo

                                                                                                                What Does Dopamine Feel Like

                                                                                                                The Physiology of Motivation and Reward

                                                                                                                Preferred States What Does Dopamine Feel Like

                                                                                                                1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                David D Nowell PhD189 May Street

                                                                                                                Worcester Mass 01602DrNowellcom

                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                wwwLulucom

                                                                                                                Identify 20 peak experiences For each peak experience identify the

                                                                                                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                clusters groupings There will probably be 4 or 5

                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                Find a word a label for each of the groupings

                                                                                                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                ldquovaluesrdquo ways that you really like to feel

                                                                                                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                Broaden and Build

                                                                                                                ldquoNeuroMalleabilityrdquo

                                                                                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                The reward-and-planning system

                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                The reward-and-planning system

                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                Lend Me Your Brain

                                                                                                                Supporting Clients with Executive Dysfunction

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                Too busy with current activity

                                                                                                                Field dependent

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Sequence problem-solve

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Block out distractions

                                                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                - E Goldberg

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Get the reward

                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                Instant gratification vs

                                                                                                                executive gratification

                                                                                                                A B C

                                                                                                                behaviorx

                                                                                                                Self-Talk Proficiency

                                                                                                                Self-Talk Proficiency

                                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                takerdquordquo

                                                                                                                Self-Talk Proficiency

                                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                                Self-Talk Proficiency

                                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                thathelliprdquo

                                                                                                                Match the Picture

                                                                                                                Distraction Delay Training

                                                                                                                Executive Estimates Training

                                                                                                                X

                                                                                                                Learning Time

                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                Learning Time

                                                                                                                Learning Time

                                                                                                                Learning Time

                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                Asking two questionshellip

                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                Am I having fun nowIs

                                                                                                                this

                                                                                                                what

                                                                                                                I se

                                                                                                                t out

                                                                                                                to

                                                                                                                do

                                                                                                                bullYesbullYes

                                                                                                                bullNobullYes

                                                                                                                bullYesbullNo

                                                                                                                bullNobullNo

                                                                                                                Am I having fun nowIs

                                                                                                                this

                                                                                                                what

                                                                                                                I se

                                                                                                                t out

                                                                                                                to

                                                                                                                do

                                                                                                                bullFunbullOn-task

                                                                                                                bullNot funbullOn-task

                                                                                                                bullFunbullNot on-task

                                                                                                                bullNot funbullNot on-task

                                                                                                                Key Features of Video Games

                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                Key Features of Video Games

                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                Volkow et al 2004

                                                                                                                Increase salience

                                                                                                                Increase salience

                                                                                                                Quarterly QI review

                                                                                                                The post-mortem

                                                                                                                Your 1 Organizational Tool

                                                                                                                Your 1 Organizational Tool

                                                                                                                Yoga read

                                                                                                                Staff meeting

                                                                                                                Planningsession

                                                                                                                Phone calls

                                                                                                                billing

                                                                                                                Your 1 Organizational Tool

                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                Your 1 Organizational Tool

                                                                                                                Learn French

                                                                                                                Stop smoking

                                                                                                                Be a better spouse

                                                                                                                The ldquoBig Fiverdquo

                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                The ldquoBig Fiverdquo

                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                The ldquoBig Fiverdquo

                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                The ldquoBig Fiverdquo

                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                The ldquoBig Fiverdquo

                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                A CHALLENGEhellip

                                                                                                                wwwDrNowellcom

                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                DavidNowellSeminars

                                                                                                                DavidNowell

                                                                                                                • Slide 1
                                                                                                                • hellipa challenge
                                                                                                                • Slide 3
                                                                                                                • Perspective of this workshophellip
                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                • Slide 7
                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                • Overview
                                                                                                                • This Dense Pudding
                                                                                                                • Sensory Processing Disorder
                                                                                                                • Slide 12
                                                                                                                • Slide 13
                                                                                                                • Developmental considerations
                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                • Slide 17
                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                • Slide 19
                                                                                                                • Strategies
                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                • Slide 22
                                                                                                                • Slide 23
                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                • Slide 25
                                                                                                                • Central Auditory Processing Disorder
                                                                                                                • Slide 27
                                                                                                                • Slide 28
                                                                                                                • Slide 29
                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                • CAPD or ADHD
                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                • Slide 35
                                                                                                                • Strategies (2)
                                                                                                                • (C)APD
                                                                                                                • Treatment for CAPD
                                                                                                                • Treatment for CAPD (2)
                                                                                                                • Self-assessment
                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                • Slide 42
                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                • (85 ndash X) x 365
                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                • Core symptoms
                                                                                                                • Core symptoms (2)
                                                                                                                • hellipand the rest of the criteria
                                                                                                                • Slide 49
                                                                                                                • Functional impact of core symptoms
                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                • Slide 53
                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                • Subtypes of ADHD
                                                                                                                • Subtypes of ADHD (2)
                                                                                                                • Common comorbidities with ADHD
                                                                                                                • Slide 63
                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                • ADHD and girls
                                                                                                                • Slide 66
                                                                                                                • Slide 67
                                                                                                                • ADHD and women
                                                                                                                • Slide 69
                                                                                                                • ADHD and women (2)
                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                • The Executive Functions
                                                                                                                • The Executive Functions (2)
                                                                                                                • Slide 74
                                                                                                                • Slide 75
                                                                                                                • Appropriate expectations
                                                                                                                • Age-appropriate expectations
                                                                                                                • Age-appropriate expectations (2)
                                                                                                                • Age-appropriate expectations (3)
                                                                                                                • Age-appropriate expectations (4)
                                                                                                                • Age-appropriate expectations (5)
                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                • Slide 84
                                                                                                                • Slide 85
                                                                                                                • Strategies (3)
                                                                                                                • Pharmacotherapy
                                                                                                                • Behavioral Supports
                                                                                                                • Slide 89
                                                                                                                • Slide 90
                                                                                                                • Slide 91
                                                                                                                • Slide 92
                                                                                                                • Slide 93
                                                                                                                • Slide 94
                                                                                                                • Slide 95
                                                                                                                • Slide 96
                                                                                                                • Slide 97
                                                                                                                • Slide 98
                                                                                                                • Slide 99
                                                                                                                • Slide 100
                                                                                                                • Slide 101
                                                                                                                • Slide 102
                                                                                                                • Slide 103
                                                                                                                • Slide 104
                                                                                                                • Slide 105
                                                                                                                • Slide 106
                                                                                                                • Slide 107
                                                                                                                • Slide 108
                                                                                                                • Slide 109
                                                                                                                • Slide 110
                                                                                                                • Time Out
                                                                                                                • Token economy
                                                                                                                • Slide 113
                                                                                                                • Slide 114
                                                                                                                • Slide 115
                                                                                                                • Intrinsic motivation
                                                                                                                • Slide 117
                                                                                                                • Slide 118
                                                                                                                • Slide 119
                                                                                                                • Metacognition
                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                • What Does Dopamine Feel Like
                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                • Slide 124
                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                • Slide 128
                                                                                                                • Slide 129
                                                                                                                • Broaden and Build
                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                • The reward-and-planning system
                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                • The reward-and-planning system (2)
                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                • Slide 141
                                                                                                                • Lend Me Your Brain
                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                • Slide 146
                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                • Slide 149
                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                • Slide 152
                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                • Slide 154
                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                • Slide 157
                                                                                                                • Slide 158
                                                                                                                • Slide 159
                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                • Slide 162
                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                • Slide 164
                                                                                                                • Instant gratification vs executive gratification
                                                                                                                • Slide 166
                                                                                                                • Slide 167
                                                                                                                • Slide 168
                                                                                                                • Slide 169
                                                                                                                • Slide 170
                                                                                                                • Self-Talk Proficiency
                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                • Match the Picture
                                                                                                                • Slide 176
                                                                                                                • Slide 177
                                                                                                                • Distraction Delay Training
                                                                                                                • Slide 179
                                                                                                                • Slide 180
                                                                                                                • Executive Estimates Training
                                                                                                                • Learning Time
                                                                                                                • Learning Time (2)
                                                                                                                • Learning Time (3)
                                                                                                                • Slide 185
                                                                                                                • Slide 186
                                                                                                                • Learning Time (4)
                                                                                                                • Asking two questionshellip
                                                                                                                • Slide 189
                                                                                                                • Slide 190
                                                                                                                • Key Features of Video Games
                                                                                                                • Key Features of Video Games (2)
                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                • Slide 194
                                                                                                                • Slide 195
                                                                                                                • Slide 196
                                                                                                                • Slide 197
                                                                                                                • Slide 198
                                                                                                                • Slide 199
                                                                                                                • Slide 200
                                                                                                                • Slide 201
                                                                                                                • Quarterly QI review
                                                                                                                • The post-mortem
                                                                                                                • Slide 204
                                                                                                                • Slide 205
                                                                                                                • Slide 206
                                                                                                                • Slide 207
                                                                                                                • Slide 208
                                                                                                                • Slide 209
                                                                                                                • Slide 210
                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                • Slide 212
                                                                                                                • Slide 213
                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                • Slide 215
                                                                                                                • Slide 216
                                                                                                                • Slide 217
                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                • A challengehellip
                                                                                                                • Slide 222

                                                                                                                  Appropriate expectations

                                                                                                                  Age-appropriate expectations

                                                                                                                  Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                                  Age-appropriate expectations

                                                                                                                  K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                                  3rd ndash 5th

                                                                                                                  Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                                  Age-appropriate expectations

                                                                                                                  6th ndash 8th

                                                                                                                  complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                                  Age-appropriate expectations

                                                                                                                  Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                                  already made Take othersrsquo perspective

                                                                                                                  Age-appropriate expectations

                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                  Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                  Strategies

                                                                                                                  Pharmacotherapy

                                                                                                                  X

                                                                                                                  Behavioral Supports

                                                                                                                  A B C

                                                                                                                  A B C

                                                                                                                  behavior

                                                                                                                  A B C

                                                                                                                  consequences

                                                                                                                  A B C

                                                                                                                  antecedent

                                                                                                                  A B C

                                                                                                                  A B C

                                                                                                                  antecedent

                                                                                                                  A B C

                                                                                                                  antecedent

                                                                                                                  easy hard

                                                                                                                  A B C

                                                                                                                  consequences

                                                                                                                  R P

                                                                                                                  +

                                                                                                                  -

                                                                                                                  R+ P+

                                                                                                                  R- P-

                                                                                                                  Time Out

                                                                                                                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                  Token economy

                                                                                                                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                  Intrinsic motivation

                                                                                                                  A B C

                                                                                                                  consequencesX

                                                                                                                  A B C

                                                                                                                  behavior

                                                                                                                  Metacognition

                                                                                                                  Metacognitive knowledge Metacognitive strategies

                                                                                                                  ldquoLend Me Your Brainrdquo

                                                                                                                  What Does Dopamine Feel Like

                                                                                                                  The Physiology of Motivation and Reward

                                                                                                                  Preferred States What Does Dopamine Feel Like

                                                                                                                  1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                  David D Nowell PhD189 May Street

                                                                                                                  Worcester Mass 01602DrNowellcom

                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                  wwwLulucom

                                                                                                                  Identify 20 peak experiences For each peak experience identify the

                                                                                                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                  of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                  clusters groupings There will probably be 4 or 5

                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                  Find a word a label for each of the groupings

                                                                                                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                  ldquovaluesrdquo ways that you really like to feel

                                                                                                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                  Broaden and Build

                                                                                                                  ldquoNeuroMalleabilityrdquo

                                                                                                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                  The reward-and-planning system

                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                  The reward-and-planning system

                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                  Lend Me Your Brain

                                                                                                                  Supporting Clients with Executive Dysfunction

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                  Too busy with current activity

                                                                                                                  Field dependent

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Sequence problem-solve

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Block out distractions

                                                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                  - E Goldberg

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Get the reward

                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                  Instant gratification vs

                                                                                                                  executive gratification

                                                                                                                  A B C

                                                                                                                  behaviorx

                                                                                                                  Self-Talk Proficiency

                                                                                                                  Self-Talk Proficiency

                                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                  takerdquordquo

                                                                                                                  Self-Talk Proficiency

                                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                                  Self-Talk Proficiency

                                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                  thathelliprdquo

                                                                                                                  Match the Picture

                                                                                                                  Distraction Delay Training

                                                                                                                  Executive Estimates Training

                                                                                                                  X

                                                                                                                  Learning Time

                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                  Learning Time

                                                                                                                  Learning Time

                                                                                                                  Learning Time

                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                  Asking two questionshellip

                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                  Am I having fun nowIs

                                                                                                                  this

                                                                                                                  what

                                                                                                                  I se

                                                                                                                  t out

                                                                                                                  to

                                                                                                                  do

                                                                                                                  bullYesbullYes

                                                                                                                  bullNobullYes

                                                                                                                  bullYesbullNo

                                                                                                                  bullNobullNo

                                                                                                                  Am I having fun nowIs

                                                                                                                  this

                                                                                                                  what

                                                                                                                  I se

                                                                                                                  t out

                                                                                                                  to

                                                                                                                  do

                                                                                                                  bullFunbullOn-task

                                                                                                                  bullNot funbullOn-task

                                                                                                                  bullFunbullNot on-task

                                                                                                                  bullNot funbullNot on-task

                                                                                                                  Key Features of Video Games

                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                  Key Features of Video Games

                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                  Volkow et al 2004

                                                                                                                  Increase salience

                                                                                                                  Increase salience

                                                                                                                  Quarterly QI review

                                                                                                                  The post-mortem

                                                                                                                  Your 1 Organizational Tool

                                                                                                                  Your 1 Organizational Tool

                                                                                                                  Yoga read

                                                                                                                  Staff meeting

                                                                                                                  Planningsession

                                                                                                                  Phone calls

                                                                                                                  billing

                                                                                                                  Your 1 Organizational Tool

                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                  Your 1 Organizational Tool

                                                                                                                  Learn French

                                                                                                                  Stop smoking

                                                                                                                  Be a better spouse

                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                  A CHALLENGEhellip

                                                                                                                  wwwDrNowellcom

                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                  DavidNowellSeminars

                                                                                                                  DavidNowell

                                                                                                                  • Slide 1
                                                                                                                  • hellipa challenge
                                                                                                                  • Slide 3
                                                                                                                  • Perspective of this workshophellip
                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                  • Slide 7
                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                  • Overview
                                                                                                                  • This Dense Pudding
                                                                                                                  • Sensory Processing Disorder
                                                                                                                  • Slide 12
                                                                                                                  • Slide 13
                                                                                                                  • Developmental considerations
                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                  • Slide 17
                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                  • Slide 19
                                                                                                                  • Strategies
                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                  • Slide 22
                                                                                                                  • Slide 23
                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                  • Slide 25
                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                  • Slide 27
                                                                                                                  • Slide 28
                                                                                                                  • Slide 29
                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                  • CAPD or ADHD
                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                  • Slide 35
                                                                                                                  • Strategies (2)
                                                                                                                  • (C)APD
                                                                                                                  • Treatment for CAPD
                                                                                                                  • Treatment for CAPD (2)
                                                                                                                  • Self-assessment
                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                  • Slide 42
                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                  • (85 ndash X) x 365
                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                  • Core symptoms
                                                                                                                  • Core symptoms (2)
                                                                                                                  • hellipand the rest of the criteria
                                                                                                                  • Slide 49
                                                                                                                  • Functional impact of core symptoms
                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                  • Slide 53
                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                  • Subtypes of ADHD
                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                  • Common comorbidities with ADHD
                                                                                                                  • Slide 63
                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                  • ADHD and girls
                                                                                                                  • Slide 66
                                                                                                                  • Slide 67
                                                                                                                  • ADHD and women
                                                                                                                  • Slide 69
                                                                                                                  • ADHD and women (2)
                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                  • The Executive Functions
                                                                                                                  • The Executive Functions (2)
                                                                                                                  • Slide 74
                                                                                                                  • Slide 75
                                                                                                                  • Appropriate expectations
                                                                                                                  • Age-appropriate expectations
                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                  • Slide 84
                                                                                                                  • Slide 85
                                                                                                                  • Strategies (3)
                                                                                                                  • Pharmacotherapy
                                                                                                                  • Behavioral Supports
                                                                                                                  • Slide 89
                                                                                                                  • Slide 90
                                                                                                                  • Slide 91
                                                                                                                  • Slide 92
                                                                                                                  • Slide 93
                                                                                                                  • Slide 94
                                                                                                                  • Slide 95
                                                                                                                  • Slide 96
                                                                                                                  • Slide 97
                                                                                                                  • Slide 98
                                                                                                                  • Slide 99
                                                                                                                  • Slide 100
                                                                                                                  • Slide 101
                                                                                                                  • Slide 102
                                                                                                                  • Slide 103
                                                                                                                  • Slide 104
                                                                                                                  • Slide 105
                                                                                                                  • Slide 106
                                                                                                                  • Slide 107
                                                                                                                  • Slide 108
                                                                                                                  • Slide 109
                                                                                                                  • Slide 110
                                                                                                                  • Time Out
                                                                                                                  • Token economy
                                                                                                                  • Slide 113
                                                                                                                  • Slide 114
                                                                                                                  • Slide 115
                                                                                                                  • Intrinsic motivation
                                                                                                                  • Slide 117
                                                                                                                  • Slide 118
                                                                                                                  • Slide 119
                                                                                                                  • Metacognition
                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                  • Slide 124
                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                  • Slide 128
                                                                                                                  • Slide 129
                                                                                                                  • Broaden and Build
                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                  • The reward-and-planning system
                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                  • The reward-and-planning system (2)
                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                  • Slide 141
                                                                                                                  • Lend Me Your Brain
                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                  • Slide 146
                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                  • Slide 149
                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                  • Slide 152
                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                  • Slide 154
                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                  • Slide 157
                                                                                                                  • Slide 158
                                                                                                                  • Slide 159
                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                  • Slide 162
                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                  • Slide 164
                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                  • Slide 166
                                                                                                                  • Slide 167
                                                                                                                  • Slide 168
                                                                                                                  • Slide 169
                                                                                                                  • Slide 170
                                                                                                                  • Self-Talk Proficiency
                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                  • Match the Picture
                                                                                                                  • Slide 176
                                                                                                                  • Slide 177
                                                                                                                  • Distraction Delay Training
                                                                                                                  • Slide 179
                                                                                                                  • Slide 180
                                                                                                                  • Executive Estimates Training
                                                                                                                  • Learning Time
                                                                                                                  • Learning Time (2)
                                                                                                                  • Learning Time (3)
                                                                                                                  • Slide 185
                                                                                                                  • Slide 186
                                                                                                                  • Learning Time (4)
                                                                                                                  • Asking two questionshellip
                                                                                                                  • Slide 189
                                                                                                                  • Slide 190
                                                                                                                  • Key Features of Video Games
                                                                                                                  • Key Features of Video Games (2)
                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                  • Slide 194
                                                                                                                  • Slide 195
                                                                                                                  • Slide 196
                                                                                                                  • Slide 197
                                                                                                                  • Slide 198
                                                                                                                  • Slide 199
                                                                                                                  • Slide 200
                                                                                                                  • Slide 201
                                                                                                                  • Quarterly QI review
                                                                                                                  • The post-mortem
                                                                                                                  • Slide 204
                                                                                                                  • Slide 205
                                                                                                                  • Slide 206
                                                                                                                  • Slide 207
                                                                                                                  • Slide 208
                                                                                                                  • Slide 209
                                                                                                                  • Slide 210
                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                  • Slide 212
                                                                                                                  • Slide 213
                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                  • Slide 215
                                                                                                                  • Slide 216
                                                                                                                  • Slide 217
                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                  • A challengehellip
                                                                                                                  • Slide 222

                                                                                                                    Age-appropriate expectations

                                                                                                                    Preschool 1-step errands Chores with cues Basic inhibition

                                                                                                                    Age-appropriate expectations

                                                                                                                    K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                                    3rd ndash 5th

                                                                                                                    Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                                    Age-appropriate expectations

                                                                                                                    6th ndash 8th

                                                                                                                    complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                                    Age-appropriate expectations

                                                                                                                    Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                                    already made Take othersrsquo perspective

                                                                                                                    Age-appropriate expectations

                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                    Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                    Strategies

                                                                                                                    Pharmacotherapy

                                                                                                                    X

                                                                                                                    Behavioral Supports

                                                                                                                    A B C

                                                                                                                    A B C

                                                                                                                    behavior

                                                                                                                    A B C

                                                                                                                    consequences

                                                                                                                    A B C

                                                                                                                    antecedent

                                                                                                                    A B C

                                                                                                                    A B C

                                                                                                                    antecedent

                                                                                                                    A B C

                                                                                                                    antecedent

                                                                                                                    easy hard

                                                                                                                    A B C

                                                                                                                    consequences

                                                                                                                    R P

                                                                                                                    +

                                                                                                                    -

                                                                                                                    R+ P+

                                                                                                                    R- P-

                                                                                                                    Time Out

                                                                                                                    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                    Token economy

                                                                                                                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                    Intrinsic motivation

                                                                                                                    A B C

                                                                                                                    consequencesX

                                                                                                                    A B C

                                                                                                                    behavior

                                                                                                                    Metacognition

                                                                                                                    Metacognitive knowledge Metacognitive strategies

                                                                                                                    ldquoLend Me Your Brainrdquo

                                                                                                                    What Does Dopamine Feel Like

                                                                                                                    The Physiology of Motivation and Reward

                                                                                                                    Preferred States What Does Dopamine Feel Like

                                                                                                                    1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                    David D Nowell PhD189 May Street

                                                                                                                    Worcester Mass 01602DrNowellcom

                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                    wwwLulucom

                                                                                                                    Identify 20 peak experiences For each peak experience identify the

                                                                                                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                    of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                    clusters groupings There will probably be 4 or 5

                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                    Find a word a label for each of the groupings

                                                                                                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                    ldquovaluesrdquo ways that you really like to feel

                                                                                                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                    Broaden and Build

                                                                                                                    ldquoNeuroMalleabilityrdquo

                                                                                                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                    The reward-and-planning system

                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                    The reward-and-planning system

                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                    Lend Me Your Brain

                                                                                                                    Supporting Clients with Executive Dysfunction

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                    Too busy with current activity

                                                                                                                    Field dependent

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Sequence problem-solve

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Block out distractions

                                                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                    - E Goldberg

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Get the reward

                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                    Instant gratification vs

                                                                                                                    executive gratification

                                                                                                                    A B C

                                                                                                                    behaviorx

                                                                                                                    Self-Talk Proficiency

                                                                                                                    Self-Talk Proficiency

                                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                    takerdquordquo

                                                                                                                    Self-Talk Proficiency

                                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                                    Self-Talk Proficiency

                                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                    thathelliprdquo

                                                                                                                    Match the Picture

                                                                                                                    Distraction Delay Training

                                                                                                                    Executive Estimates Training

                                                                                                                    X

                                                                                                                    Learning Time

                                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                    Learning Time

                                                                                                                    Learning Time

                                                                                                                    Learning Time

                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                    Asking two questionshellip

                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                    Am I having fun nowIs

                                                                                                                    this

                                                                                                                    what

                                                                                                                    I se

                                                                                                                    t out

                                                                                                                    to

                                                                                                                    do

                                                                                                                    bullYesbullYes

                                                                                                                    bullNobullYes

                                                                                                                    bullYesbullNo

                                                                                                                    bullNobullNo

                                                                                                                    Am I having fun nowIs

                                                                                                                    this

                                                                                                                    what

                                                                                                                    I se

                                                                                                                    t out

                                                                                                                    to

                                                                                                                    do

                                                                                                                    bullFunbullOn-task

                                                                                                                    bullNot funbullOn-task

                                                                                                                    bullFunbullNot on-task

                                                                                                                    bullNot funbullNot on-task

                                                                                                                    Key Features of Video Games

                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                    Key Features of Video Games

                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                    Volkow et al 2004

                                                                                                                    Increase salience

                                                                                                                    Increase salience

                                                                                                                    Quarterly QI review

                                                                                                                    The post-mortem

                                                                                                                    Your 1 Organizational Tool

                                                                                                                    Your 1 Organizational Tool

                                                                                                                    Yoga read

                                                                                                                    Staff meeting

                                                                                                                    Planningsession

                                                                                                                    Phone calls

                                                                                                                    billing

                                                                                                                    Your 1 Organizational Tool

                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                    Your 1 Organizational Tool

                                                                                                                    Learn French

                                                                                                                    Stop smoking

                                                                                                                    Be a better spouse

                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                    A CHALLENGEhellip

                                                                                                                    wwwDrNowellcom

                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                    DavidNowellSeminars

                                                                                                                    DavidNowell

                                                                                                                    • Slide 1
                                                                                                                    • hellipa challenge
                                                                                                                    • Slide 3
                                                                                                                    • Perspective of this workshophellip
                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                    • Slide 7
                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                    • Overview
                                                                                                                    • This Dense Pudding
                                                                                                                    • Sensory Processing Disorder
                                                                                                                    • Slide 12
                                                                                                                    • Slide 13
                                                                                                                    • Developmental considerations
                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                    • Slide 17
                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                    • Slide 19
                                                                                                                    • Strategies
                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                    • Slide 22
                                                                                                                    • Slide 23
                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                    • Slide 25
                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                    • Slide 27
                                                                                                                    • Slide 28
                                                                                                                    • Slide 29
                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                    • CAPD or ADHD
                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                    • Slide 35
                                                                                                                    • Strategies (2)
                                                                                                                    • (C)APD
                                                                                                                    • Treatment for CAPD
                                                                                                                    • Treatment for CAPD (2)
                                                                                                                    • Self-assessment
                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                    • Slide 42
                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                    • (85 ndash X) x 365
                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                    • Core symptoms
                                                                                                                    • Core symptoms (2)
                                                                                                                    • hellipand the rest of the criteria
                                                                                                                    • Slide 49
                                                                                                                    • Functional impact of core symptoms
                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                    • Slide 53
                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                    • Subtypes of ADHD
                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                    • Common comorbidities with ADHD
                                                                                                                    • Slide 63
                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                    • ADHD and girls
                                                                                                                    • Slide 66
                                                                                                                    • Slide 67
                                                                                                                    • ADHD and women
                                                                                                                    • Slide 69
                                                                                                                    • ADHD and women (2)
                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                    • The Executive Functions
                                                                                                                    • The Executive Functions (2)
                                                                                                                    • Slide 74
                                                                                                                    • Slide 75
                                                                                                                    • Appropriate expectations
                                                                                                                    • Age-appropriate expectations
                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                    • Slide 84
                                                                                                                    • Slide 85
                                                                                                                    • Strategies (3)
                                                                                                                    • Pharmacotherapy
                                                                                                                    • Behavioral Supports
                                                                                                                    • Slide 89
                                                                                                                    • Slide 90
                                                                                                                    • Slide 91
                                                                                                                    • Slide 92
                                                                                                                    • Slide 93
                                                                                                                    • Slide 94
                                                                                                                    • Slide 95
                                                                                                                    • Slide 96
                                                                                                                    • Slide 97
                                                                                                                    • Slide 98
                                                                                                                    • Slide 99
                                                                                                                    • Slide 100
                                                                                                                    • Slide 101
                                                                                                                    • Slide 102
                                                                                                                    • Slide 103
                                                                                                                    • Slide 104
                                                                                                                    • Slide 105
                                                                                                                    • Slide 106
                                                                                                                    • Slide 107
                                                                                                                    • Slide 108
                                                                                                                    • Slide 109
                                                                                                                    • Slide 110
                                                                                                                    • Time Out
                                                                                                                    • Token economy
                                                                                                                    • Slide 113
                                                                                                                    • Slide 114
                                                                                                                    • Slide 115
                                                                                                                    • Intrinsic motivation
                                                                                                                    • Slide 117
                                                                                                                    • Slide 118
                                                                                                                    • Slide 119
                                                                                                                    • Metacognition
                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                    • Slide 124
                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                    • Slide 128
                                                                                                                    • Slide 129
                                                                                                                    • Broaden and Build
                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                    • The reward-and-planning system
                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                    • The reward-and-planning system (2)
                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                    • Slide 141
                                                                                                                    • Lend Me Your Brain
                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                    • Slide 146
                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                    • Slide 149
                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                    • Slide 152
                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                    • Slide 154
                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                    • Slide 157
                                                                                                                    • Slide 158
                                                                                                                    • Slide 159
                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                    • Slide 162
                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                    • Slide 164
                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                    • Slide 166
                                                                                                                    • Slide 167
                                                                                                                    • Slide 168
                                                                                                                    • Slide 169
                                                                                                                    • Slide 170
                                                                                                                    • Self-Talk Proficiency
                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                    • Match the Picture
                                                                                                                    • Slide 176
                                                                                                                    • Slide 177
                                                                                                                    • Distraction Delay Training
                                                                                                                    • Slide 179
                                                                                                                    • Slide 180
                                                                                                                    • Executive Estimates Training
                                                                                                                    • Learning Time
                                                                                                                    • Learning Time (2)
                                                                                                                    • Learning Time (3)
                                                                                                                    • Slide 185
                                                                                                                    • Slide 186
                                                                                                                    • Learning Time (4)
                                                                                                                    • Asking two questionshellip
                                                                                                                    • Slide 189
                                                                                                                    • Slide 190
                                                                                                                    • Key Features of Video Games
                                                                                                                    • Key Features of Video Games (2)
                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                    • Slide 194
                                                                                                                    • Slide 195
                                                                                                                    • Slide 196
                                                                                                                    • Slide 197
                                                                                                                    • Slide 198
                                                                                                                    • Slide 199
                                                                                                                    • Slide 200
                                                                                                                    • Slide 201
                                                                                                                    • Quarterly QI review
                                                                                                                    • The post-mortem
                                                                                                                    • Slide 204
                                                                                                                    • Slide 205
                                                                                                                    • Slide 206
                                                                                                                    • Slide 207
                                                                                                                    • Slide 208
                                                                                                                    • Slide 209
                                                                                                                    • Slide 210
                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                    • Slide 212
                                                                                                                    • Slide 213
                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                    • Slide 215
                                                                                                                    • Slide 216
                                                                                                                    • Slide 217
                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                    • A challengehellip
                                                                                                                    • Slide 222

                                                                                                                      Age-appropriate expectations

                                                                                                                      K ndash 2nd grade 2-3 step directions Bring papers home 20-30 minute assignments Simple spending decisions Follow rules inhibit no grabbing

                                                                                                                      3rd ndash 5th

                                                                                                                      Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                                      Age-appropriate expectations

                                                                                                                      6th ndash 8th

                                                                                                                      complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                                      Age-appropriate expectations

                                                                                                                      Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                                      already made Take othersrsquo perspective

                                                                                                                      Age-appropriate expectations

                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                      Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                      Strategies

                                                                                                                      Pharmacotherapy

                                                                                                                      X

                                                                                                                      Behavioral Supports

                                                                                                                      A B C

                                                                                                                      A B C

                                                                                                                      behavior

                                                                                                                      A B C

                                                                                                                      consequences

                                                                                                                      A B C

                                                                                                                      antecedent

                                                                                                                      A B C

                                                                                                                      A B C

                                                                                                                      antecedent

                                                                                                                      A B C

                                                                                                                      antecedent

                                                                                                                      easy hard

                                                                                                                      A B C

                                                                                                                      consequences

                                                                                                                      R P

                                                                                                                      +

                                                                                                                      -

                                                                                                                      R+ P+

                                                                                                                      R- P-

                                                                                                                      Time Out

                                                                                                                      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                      Token economy

                                                                                                                      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                      Intrinsic motivation

                                                                                                                      A B C

                                                                                                                      consequencesX

                                                                                                                      A B C

                                                                                                                      behavior

                                                                                                                      Metacognition

                                                                                                                      Metacognitive knowledge Metacognitive strategies

                                                                                                                      ldquoLend Me Your Brainrdquo

                                                                                                                      What Does Dopamine Feel Like

                                                                                                                      The Physiology of Motivation and Reward

                                                                                                                      Preferred States What Does Dopamine Feel Like

                                                                                                                      1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                      David D Nowell PhD189 May Street

                                                                                                                      Worcester Mass 01602DrNowellcom

                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                      wwwLulucom

                                                                                                                      Identify 20 peak experiences For each peak experience identify the

                                                                                                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                      of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                      clusters groupings There will probably be 4 or 5

                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                      Find a word a label for each of the groupings

                                                                                                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                      ldquovaluesrdquo ways that you really like to feel

                                                                                                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                      Broaden and Build

                                                                                                                      ldquoNeuroMalleabilityrdquo

                                                                                                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                      The reward-and-planning system

                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                      The reward-and-planning system

                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                      Lend Me Your Brain

                                                                                                                      Supporting Clients with Executive Dysfunction

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                      Too busy with current activity

                                                                                                                      Field dependent

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Sequence problem-solve

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Block out distractions

                                                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                      - E Goldberg

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Get the reward

                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                      Instant gratification vs

                                                                                                                      executive gratification

                                                                                                                      A B C

                                                                                                                      behaviorx

                                                                                                                      Self-Talk Proficiency

                                                                                                                      Self-Talk Proficiency

                                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                      takerdquordquo

                                                                                                                      Self-Talk Proficiency

                                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                                      Self-Talk Proficiency

                                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                      thathelliprdquo

                                                                                                                      Match the Picture

                                                                                                                      Distraction Delay Training

                                                                                                                      Executive Estimates Training

                                                                                                                      X

                                                                                                                      Learning Time

                                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                      Learning Time

                                                                                                                      Learning Time

                                                                                                                      Learning Time

                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                      Asking two questionshellip

                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                      Am I having fun nowIs

                                                                                                                      this

                                                                                                                      what

                                                                                                                      I se

                                                                                                                      t out

                                                                                                                      to

                                                                                                                      do

                                                                                                                      bullYesbullYes

                                                                                                                      bullNobullYes

                                                                                                                      bullYesbullNo

                                                                                                                      bullNobullNo

                                                                                                                      Am I having fun nowIs

                                                                                                                      this

                                                                                                                      what

                                                                                                                      I se

                                                                                                                      t out

                                                                                                                      to

                                                                                                                      do

                                                                                                                      bullFunbullOn-task

                                                                                                                      bullNot funbullOn-task

                                                                                                                      bullFunbullNot on-task

                                                                                                                      bullNot funbullNot on-task

                                                                                                                      Key Features of Video Games

                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                      Key Features of Video Games

                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                      Volkow et al 2004

                                                                                                                      Increase salience

                                                                                                                      Increase salience

                                                                                                                      Quarterly QI review

                                                                                                                      The post-mortem

                                                                                                                      Your 1 Organizational Tool

                                                                                                                      Your 1 Organizational Tool

                                                                                                                      Yoga read

                                                                                                                      Staff meeting

                                                                                                                      Planningsession

                                                                                                                      Phone calls

                                                                                                                      billing

                                                                                                                      Your 1 Organizational Tool

                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                      Your 1 Organizational Tool

                                                                                                                      Learn French

                                                                                                                      Stop smoking

                                                                                                                      Be a better spouse

                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                      A CHALLENGEhellip

                                                                                                                      wwwDrNowellcom

                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                      DavidNowellSeminars

                                                                                                                      DavidNowell

                                                                                                                      • Slide 1
                                                                                                                      • hellipa challenge
                                                                                                                      • Slide 3
                                                                                                                      • Perspective of this workshophellip
                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                      • Slide 7
                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                      • Overview
                                                                                                                      • This Dense Pudding
                                                                                                                      • Sensory Processing Disorder
                                                                                                                      • Slide 12
                                                                                                                      • Slide 13
                                                                                                                      • Developmental considerations
                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                      • Slide 17
                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                      • Slide 19
                                                                                                                      • Strategies
                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                      • Slide 22
                                                                                                                      • Slide 23
                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                      • Slide 25
                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                      • Slide 27
                                                                                                                      • Slide 28
                                                                                                                      • Slide 29
                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                      • CAPD or ADHD
                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                      • Slide 35
                                                                                                                      • Strategies (2)
                                                                                                                      • (C)APD
                                                                                                                      • Treatment for CAPD
                                                                                                                      • Treatment for CAPD (2)
                                                                                                                      • Self-assessment
                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                      • Slide 42
                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                      • (85 ndash X) x 365
                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                      • Core symptoms
                                                                                                                      • Core symptoms (2)
                                                                                                                      • hellipand the rest of the criteria
                                                                                                                      • Slide 49
                                                                                                                      • Functional impact of core symptoms
                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                      • Slide 53
                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                      • Subtypes of ADHD
                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                      • Common comorbidities with ADHD
                                                                                                                      • Slide 63
                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                      • ADHD and girls
                                                                                                                      • Slide 66
                                                                                                                      • Slide 67
                                                                                                                      • ADHD and women
                                                                                                                      • Slide 69
                                                                                                                      • ADHD and women (2)
                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                      • The Executive Functions
                                                                                                                      • The Executive Functions (2)
                                                                                                                      • Slide 74
                                                                                                                      • Slide 75
                                                                                                                      • Appropriate expectations
                                                                                                                      • Age-appropriate expectations
                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                      • Slide 84
                                                                                                                      • Slide 85
                                                                                                                      • Strategies (3)
                                                                                                                      • Pharmacotherapy
                                                                                                                      • Behavioral Supports
                                                                                                                      • Slide 89
                                                                                                                      • Slide 90
                                                                                                                      • Slide 91
                                                                                                                      • Slide 92
                                                                                                                      • Slide 93
                                                                                                                      • Slide 94
                                                                                                                      • Slide 95
                                                                                                                      • Slide 96
                                                                                                                      • Slide 97
                                                                                                                      • Slide 98
                                                                                                                      • Slide 99
                                                                                                                      • Slide 100
                                                                                                                      • Slide 101
                                                                                                                      • Slide 102
                                                                                                                      • Slide 103
                                                                                                                      • Slide 104
                                                                                                                      • Slide 105
                                                                                                                      • Slide 106
                                                                                                                      • Slide 107
                                                                                                                      • Slide 108
                                                                                                                      • Slide 109
                                                                                                                      • Slide 110
                                                                                                                      • Time Out
                                                                                                                      • Token economy
                                                                                                                      • Slide 113
                                                                                                                      • Slide 114
                                                                                                                      • Slide 115
                                                                                                                      • Intrinsic motivation
                                                                                                                      • Slide 117
                                                                                                                      • Slide 118
                                                                                                                      • Slide 119
                                                                                                                      • Metacognition
                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                      • Slide 124
                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                      • Slide 128
                                                                                                                      • Slide 129
                                                                                                                      • Broaden and Build
                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                      • The reward-and-planning system
                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                      • The reward-and-planning system (2)
                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                      • Slide 141
                                                                                                                      • Lend Me Your Brain
                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                      • Slide 146
                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                      • Slide 149
                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                      • Slide 152
                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                      • Slide 154
                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                      • Slide 157
                                                                                                                      • Slide 158
                                                                                                                      • Slide 159
                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                      • Slide 162
                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                      • Slide 164
                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                      • Slide 166
                                                                                                                      • Slide 167
                                                                                                                      • Slide 168
                                                                                                                      • Slide 169
                                                                                                                      • Slide 170
                                                                                                                      • Self-Talk Proficiency
                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                      • Match the Picture
                                                                                                                      • Slide 176
                                                                                                                      • Slide 177
                                                                                                                      • Distraction Delay Training
                                                                                                                      • Slide 179
                                                                                                                      • Slide 180
                                                                                                                      • Executive Estimates Training
                                                                                                                      • Learning Time
                                                                                                                      • Learning Time (2)
                                                                                                                      • Learning Time (3)
                                                                                                                      • Slide 185
                                                                                                                      • Slide 186
                                                                                                                      • Learning Time (4)
                                                                                                                      • Asking two questionshellip
                                                                                                                      • Slide 189
                                                                                                                      • Slide 190
                                                                                                                      • Key Features of Video Games
                                                                                                                      • Key Features of Video Games (2)
                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                      • Slide 194
                                                                                                                      • Slide 195
                                                                                                                      • Slide 196
                                                                                                                      • Slide 197
                                                                                                                      • Slide 198
                                                                                                                      • Slide 199
                                                                                                                      • Slide 200
                                                                                                                      • Slide 201
                                                                                                                      • Quarterly QI review
                                                                                                                      • The post-mortem
                                                                                                                      • Slide 204
                                                                                                                      • Slide 205
                                                                                                                      • Slide 206
                                                                                                                      • Slide 207
                                                                                                                      • Slide 208
                                                                                                                      • Slide 209
                                                                                                                      • Slide 210
                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                      • Slide 212
                                                                                                                      • Slide 213
                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                      • Slide 215
                                                                                                                      • Slide 216
                                                                                                                      • Slide 217
                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                      • A challengehellip
                                                                                                                      • Slide 222

                                                                                                                        3rd ndash 5th

                                                                                                                        Simple shopping list Keep track of personal items Longer homework assignments Simple project planing Keep track of variable daily schedule Save money Inhibit and regulate even wo teacher present Manners Simple delayed gratification (phone)

                                                                                                                        Age-appropriate expectations

                                                                                                                        6th ndash 8th

                                                                                                                        complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                                        Age-appropriate expectations

                                                                                                                        Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                                        already made Take othersrsquo perspective

                                                                                                                        Age-appropriate expectations

                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                        Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                        Strategies

                                                                                                                        Pharmacotherapy

                                                                                                                        X

                                                                                                                        Behavioral Supports

                                                                                                                        A B C

                                                                                                                        A B C

                                                                                                                        behavior

                                                                                                                        A B C

                                                                                                                        consequences

                                                                                                                        A B C

                                                                                                                        antecedent

                                                                                                                        A B C

                                                                                                                        A B C

                                                                                                                        antecedent

                                                                                                                        A B C

                                                                                                                        antecedent

                                                                                                                        easy hard

                                                                                                                        A B C

                                                                                                                        consequences

                                                                                                                        R P

                                                                                                                        +

                                                                                                                        -

                                                                                                                        R+ P+

                                                                                                                        R- P-

                                                                                                                        Time Out

                                                                                                                        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                        Token economy

                                                                                                                        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                        Intrinsic motivation

                                                                                                                        A B C

                                                                                                                        consequencesX

                                                                                                                        A B C

                                                                                                                        behavior

                                                                                                                        Metacognition

                                                                                                                        Metacognitive knowledge Metacognitive strategies

                                                                                                                        ldquoLend Me Your Brainrdquo

                                                                                                                        What Does Dopamine Feel Like

                                                                                                                        The Physiology of Motivation and Reward

                                                                                                                        Preferred States What Does Dopamine Feel Like

                                                                                                                        1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                        David D Nowell PhD189 May Street

                                                                                                                        Worcester Mass 01602DrNowellcom

                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                        wwwLulucom

                                                                                                                        Identify 20 peak experiences For each peak experience identify the

                                                                                                                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                        of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                        clusters groupings There will probably be 4 or 5

                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                        Find a word a label for each of the groupings

                                                                                                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                        ldquovaluesrdquo ways that you really like to feel

                                                                                                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                        Broaden and Build

                                                                                                                        ldquoNeuroMalleabilityrdquo

                                                                                                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                        The reward-and-planning system

                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                        The reward-and-planning system

                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                        Lend Me Your Brain

                                                                                                                        Supporting Clients with Executive Dysfunction

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                        Too busy with current activity

                                                                                                                        Field dependent

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Sequence problem-solve

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Block out distractions

                                                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                        - E Goldberg

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Get the reward

                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                        Instant gratification vs

                                                                                                                        executive gratification

                                                                                                                        A B C

                                                                                                                        behaviorx

                                                                                                                        Self-Talk Proficiency

                                                                                                                        Self-Talk Proficiency

                                                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                        takerdquordquo

                                                                                                                        Self-Talk Proficiency

                                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                                        Self-Talk Proficiency

                                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                        thathelliprdquo

                                                                                                                        Match the Picture

                                                                                                                        Distraction Delay Training

                                                                                                                        Executive Estimates Training

                                                                                                                        X

                                                                                                                        Learning Time

                                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                        Learning Time

                                                                                                                        Learning Time

                                                                                                                        Learning Time

                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                        Asking two questionshellip

                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                        Am I having fun nowIs

                                                                                                                        this

                                                                                                                        what

                                                                                                                        I se

                                                                                                                        t out

                                                                                                                        to

                                                                                                                        do

                                                                                                                        bullYesbullYes

                                                                                                                        bullNobullYes

                                                                                                                        bullYesbullNo

                                                                                                                        bullNobullNo

                                                                                                                        Am I having fun nowIs

                                                                                                                        this

                                                                                                                        what

                                                                                                                        I se

                                                                                                                        t out

                                                                                                                        to

                                                                                                                        do

                                                                                                                        bullFunbullOn-task

                                                                                                                        bullNot funbullOn-task

                                                                                                                        bullFunbullNot on-task

                                                                                                                        bullNot funbullNot on-task

                                                                                                                        Key Features of Video Games

                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                        Key Features of Video Games

                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                        Volkow et al 2004

                                                                                                                        Increase salience

                                                                                                                        Increase salience

                                                                                                                        Quarterly QI review

                                                                                                                        The post-mortem

                                                                                                                        Your 1 Organizational Tool

                                                                                                                        Your 1 Organizational Tool

                                                                                                                        Yoga read

                                                                                                                        Staff meeting

                                                                                                                        Planningsession

                                                                                                                        Phone calls

                                                                                                                        billing

                                                                                                                        Your 1 Organizational Tool

                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                        Your 1 Organizational Tool

                                                                                                                        Learn French

                                                                                                                        Stop smoking

                                                                                                                        Be a better spouse

                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                        A CHALLENGEhellip

                                                                                                                        wwwDrNowellcom

                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                        DavidNowellSeminars

                                                                                                                        DavidNowell

                                                                                                                        • Slide 1
                                                                                                                        • hellipa challenge
                                                                                                                        • Slide 3
                                                                                                                        • Perspective of this workshophellip
                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                        • Slide 7
                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                        • Overview
                                                                                                                        • This Dense Pudding
                                                                                                                        • Sensory Processing Disorder
                                                                                                                        • Slide 12
                                                                                                                        • Slide 13
                                                                                                                        • Developmental considerations
                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                        • Slide 17
                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                        • Slide 19
                                                                                                                        • Strategies
                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                        • Slide 22
                                                                                                                        • Slide 23
                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                        • Slide 25
                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                        • Slide 27
                                                                                                                        • Slide 28
                                                                                                                        • Slide 29
                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                        • CAPD or ADHD
                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                        • Slide 35
                                                                                                                        • Strategies (2)
                                                                                                                        • (C)APD
                                                                                                                        • Treatment for CAPD
                                                                                                                        • Treatment for CAPD (2)
                                                                                                                        • Self-assessment
                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                        • Slide 42
                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                        • (85 ndash X) x 365
                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                        • Core symptoms
                                                                                                                        • Core symptoms (2)
                                                                                                                        • hellipand the rest of the criteria
                                                                                                                        • Slide 49
                                                                                                                        • Functional impact of core symptoms
                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                        • Slide 53
                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                        • Subtypes of ADHD
                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                        • Common comorbidities with ADHD
                                                                                                                        • Slide 63
                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                        • ADHD and girls
                                                                                                                        • Slide 66
                                                                                                                        • Slide 67
                                                                                                                        • ADHD and women
                                                                                                                        • Slide 69
                                                                                                                        • ADHD and women (2)
                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                        • The Executive Functions
                                                                                                                        • The Executive Functions (2)
                                                                                                                        • Slide 74
                                                                                                                        • Slide 75
                                                                                                                        • Appropriate expectations
                                                                                                                        • Age-appropriate expectations
                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                        • Slide 84
                                                                                                                        • Slide 85
                                                                                                                        • Strategies (3)
                                                                                                                        • Pharmacotherapy
                                                                                                                        • Behavioral Supports
                                                                                                                        • Slide 89
                                                                                                                        • Slide 90
                                                                                                                        • Slide 91
                                                                                                                        • Slide 92
                                                                                                                        • Slide 93
                                                                                                                        • Slide 94
                                                                                                                        • Slide 95
                                                                                                                        • Slide 96
                                                                                                                        • Slide 97
                                                                                                                        • Slide 98
                                                                                                                        • Slide 99
                                                                                                                        • Slide 100
                                                                                                                        • Slide 101
                                                                                                                        • Slide 102
                                                                                                                        • Slide 103
                                                                                                                        • Slide 104
                                                                                                                        • Slide 105
                                                                                                                        • Slide 106
                                                                                                                        • Slide 107
                                                                                                                        • Slide 108
                                                                                                                        • Slide 109
                                                                                                                        • Slide 110
                                                                                                                        • Time Out
                                                                                                                        • Token economy
                                                                                                                        • Slide 113
                                                                                                                        • Slide 114
                                                                                                                        • Slide 115
                                                                                                                        • Intrinsic motivation
                                                                                                                        • Slide 117
                                                                                                                        • Slide 118
                                                                                                                        • Slide 119
                                                                                                                        • Metacognition
                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                        • Slide 124
                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                        • Slide 128
                                                                                                                        • Slide 129
                                                                                                                        • Broaden and Build
                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                        • The reward-and-planning system
                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                        • The reward-and-planning system (2)
                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                        • Slide 141
                                                                                                                        • Lend Me Your Brain
                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                        • Slide 146
                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                        • Slide 149
                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                        • Slide 152
                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                        • Slide 154
                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                        • Slide 157
                                                                                                                        • Slide 158
                                                                                                                        • Slide 159
                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                        • Slide 162
                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                        • Slide 164
                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                        • Slide 166
                                                                                                                        • Slide 167
                                                                                                                        • Slide 168
                                                                                                                        • Slide 169
                                                                                                                        • Slide 170
                                                                                                                        • Self-Talk Proficiency
                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                        • Match the Picture
                                                                                                                        • Slide 176
                                                                                                                        • Slide 177
                                                                                                                        • Distraction Delay Training
                                                                                                                        • Slide 179
                                                                                                                        • Slide 180
                                                                                                                        • Executive Estimates Training
                                                                                                                        • Learning Time
                                                                                                                        • Learning Time (2)
                                                                                                                        • Learning Time (3)
                                                                                                                        • Slide 185
                                                                                                                        • Slide 186
                                                                                                                        • Learning Time (4)
                                                                                                                        • Asking two questionshellip
                                                                                                                        • Slide 189
                                                                                                                        • Slide 190
                                                                                                                        • Key Features of Video Games
                                                                                                                        • Key Features of Video Games (2)
                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                        • Slide 194
                                                                                                                        • Slide 195
                                                                                                                        • Slide 196
                                                                                                                        • Slide 197
                                                                                                                        • Slide 198
                                                                                                                        • Slide 199
                                                                                                                        • Slide 200
                                                                                                                        • Slide 201
                                                                                                                        • Quarterly QI review
                                                                                                                        • The post-mortem
                                                                                                                        • Slide 204
                                                                                                                        • Slide 205
                                                                                                                        • Slide 206
                                                                                                                        • Slide 207
                                                                                                                        • Slide 208
                                                                                                                        • Slide 209
                                                                                                                        • Slide 210
                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                        • Slide 212
                                                                                                                        • Slide 213
                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                        • Slide 215
                                                                                                                        • Slide 216
                                                                                                                        • Slide 217
                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                        • A challengehellip
                                                                                                                        • Slide 222

                                                                                                                          6th ndash 8th

                                                                                                                          complex chores Babysitting Organizing system Complex schedule Longer term projects Time management Self soothe Manage conflict

                                                                                                                          Age-appropriate expectations

                                                                                                                          Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                                          already made Take othersrsquo perspective

                                                                                                                          Age-appropriate expectations

                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                          Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                          Strategies

                                                                                                                          Pharmacotherapy

                                                                                                                          X

                                                                                                                          Behavioral Supports

                                                                                                                          A B C

                                                                                                                          A B C

                                                                                                                          behavior

                                                                                                                          A B C

                                                                                                                          consequences

                                                                                                                          A B C

                                                                                                                          antecedent

                                                                                                                          A B C

                                                                                                                          A B C

                                                                                                                          antecedent

                                                                                                                          A B C

                                                                                                                          antecedent

                                                                                                                          easy hard

                                                                                                                          A B C

                                                                                                                          consequences

                                                                                                                          R P

                                                                                                                          +

                                                                                                                          -

                                                                                                                          R+ P+

                                                                                                                          R- P-

                                                                                                                          Time Out

                                                                                                                          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                          Token economy

                                                                                                                          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                          Intrinsic motivation

                                                                                                                          A B C

                                                                                                                          consequencesX

                                                                                                                          A B C

                                                                                                                          behavior

                                                                                                                          Metacognition

                                                                                                                          Metacognitive knowledge Metacognitive strategies

                                                                                                                          ldquoLend Me Your Brainrdquo

                                                                                                                          What Does Dopamine Feel Like

                                                                                                                          The Physiology of Motivation and Reward

                                                                                                                          Preferred States What Does Dopamine Feel Like

                                                                                                                          1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                          David D Nowell PhD189 May Street

                                                                                                                          Worcester Mass 01602DrNowellcom

                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                          wwwLulucom

                                                                                                                          Identify 20 peak experiences For each peak experience identify the

                                                                                                                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                          of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                          clusters groupings There will probably be 4 or 5

                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                          Find a word a label for each of the groupings

                                                                                                                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                          ldquovaluesrdquo ways that you really like to feel

                                                                                                                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                          Broaden and Build

                                                                                                                          ldquoNeuroMalleabilityrdquo

                                                                                                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                          The reward-and-planning system

                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                          The reward-and-planning system

                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                          Lend Me Your Brain

                                                                                                                          Supporting Clients with Executive Dysfunction

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                          Too busy with current activity

                                                                                                                          Field dependent

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Sequence problem-solve

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Block out distractions

                                                                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                          - E Goldberg

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Get the reward

                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                          Instant gratification vs

                                                                                                                          executive gratification

                                                                                                                          A B C

                                                                                                                          behaviorx

                                                                                                                          Self-Talk Proficiency

                                                                                                                          Self-Talk Proficiency

                                                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                          takerdquordquo

                                                                                                                          Self-Talk Proficiency

                                                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                                                          Self-Talk Proficiency

                                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                          thathelliprdquo

                                                                                                                          Match the Picture

                                                                                                                          Distraction Delay Training

                                                                                                                          Executive Estimates Training

                                                                                                                          X

                                                                                                                          Learning Time

                                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                          Learning Time

                                                                                                                          Learning Time

                                                                                                                          Learning Time

                                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                          Asking two questionshellip

                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                          Am I having fun nowIs

                                                                                                                          this

                                                                                                                          what

                                                                                                                          I se

                                                                                                                          t out

                                                                                                                          to

                                                                                                                          do

                                                                                                                          bullYesbullYes

                                                                                                                          bullNobullYes

                                                                                                                          bullYesbullNo

                                                                                                                          bullNobullNo

                                                                                                                          Am I having fun nowIs

                                                                                                                          this

                                                                                                                          what

                                                                                                                          I se

                                                                                                                          t out

                                                                                                                          to

                                                                                                                          do

                                                                                                                          bullFunbullOn-task

                                                                                                                          bullNot funbullOn-task

                                                                                                                          bullFunbullNot on-task

                                                                                                                          bullNot funbullNot on-task

                                                                                                                          Key Features of Video Games

                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                          Key Features of Video Games

                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                          Volkow et al 2004

                                                                                                                          Increase salience

                                                                                                                          Increase salience

                                                                                                                          Quarterly QI review

                                                                                                                          The post-mortem

                                                                                                                          Your 1 Organizational Tool

                                                                                                                          Your 1 Organizational Tool

                                                                                                                          Yoga read

                                                                                                                          Staff meeting

                                                                                                                          Planningsession

                                                                                                                          Phone calls

                                                                                                                          billing

                                                                                                                          Your 1 Organizational Tool

                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                          Your 1 Organizational Tool

                                                                                                                          Learn French

                                                                                                                          Stop smoking

                                                                                                                          Be a better spouse

                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                          A CHALLENGEhellip

                                                                                                                          wwwDrNowellcom

                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                          DavidNowellSeminars

                                                                                                                          DavidNowell

                                                                                                                          • Slide 1
                                                                                                                          • hellipa challenge
                                                                                                                          • Slide 3
                                                                                                                          • Perspective of this workshophellip
                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                          • Slide 7
                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                          • Overview
                                                                                                                          • This Dense Pudding
                                                                                                                          • Sensory Processing Disorder
                                                                                                                          • Slide 12
                                                                                                                          • Slide 13
                                                                                                                          • Developmental considerations
                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                          • Slide 17
                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                          • Slide 19
                                                                                                                          • Strategies
                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                          • Slide 22
                                                                                                                          • Slide 23
                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                          • Slide 25
                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                          • Slide 27
                                                                                                                          • Slide 28
                                                                                                                          • Slide 29
                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                          • CAPD or ADHD
                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                          • Slide 35
                                                                                                                          • Strategies (2)
                                                                                                                          • (C)APD
                                                                                                                          • Treatment for CAPD
                                                                                                                          • Treatment for CAPD (2)
                                                                                                                          • Self-assessment
                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                          • Slide 42
                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                          • (85 ndash X) x 365
                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                          • Core symptoms
                                                                                                                          • Core symptoms (2)
                                                                                                                          • hellipand the rest of the criteria
                                                                                                                          • Slide 49
                                                                                                                          • Functional impact of core symptoms
                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                          • Slide 53
                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                          • Subtypes of ADHD
                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                          • Common comorbidities with ADHD
                                                                                                                          • Slide 63
                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                          • ADHD and girls
                                                                                                                          • Slide 66
                                                                                                                          • Slide 67
                                                                                                                          • ADHD and women
                                                                                                                          • Slide 69
                                                                                                                          • ADHD and women (2)
                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                          • The Executive Functions
                                                                                                                          • The Executive Functions (2)
                                                                                                                          • Slide 74
                                                                                                                          • Slide 75
                                                                                                                          • Appropriate expectations
                                                                                                                          • Age-appropriate expectations
                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                          • Slide 84
                                                                                                                          • Slide 85
                                                                                                                          • Strategies (3)
                                                                                                                          • Pharmacotherapy
                                                                                                                          • Behavioral Supports
                                                                                                                          • Slide 89
                                                                                                                          • Slide 90
                                                                                                                          • Slide 91
                                                                                                                          • Slide 92
                                                                                                                          • Slide 93
                                                                                                                          • Slide 94
                                                                                                                          • Slide 95
                                                                                                                          • Slide 96
                                                                                                                          • Slide 97
                                                                                                                          • Slide 98
                                                                                                                          • Slide 99
                                                                                                                          • Slide 100
                                                                                                                          • Slide 101
                                                                                                                          • Slide 102
                                                                                                                          • Slide 103
                                                                                                                          • Slide 104
                                                                                                                          • Slide 105
                                                                                                                          • Slide 106
                                                                                                                          • Slide 107
                                                                                                                          • Slide 108
                                                                                                                          • Slide 109
                                                                                                                          • Slide 110
                                                                                                                          • Time Out
                                                                                                                          • Token economy
                                                                                                                          • Slide 113
                                                                                                                          • Slide 114
                                                                                                                          • Slide 115
                                                                                                                          • Intrinsic motivation
                                                                                                                          • Slide 117
                                                                                                                          • Slide 118
                                                                                                                          • Slide 119
                                                                                                                          • Metacognition
                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                          • Slide 124
                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                          • Slide 128
                                                                                                                          • Slide 129
                                                                                                                          • Broaden and Build
                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                          • The reward-and-planning system
                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                          • The reward-and-planning system (2)
                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                          • Slide 141
                                                                                                                          • Lend Me Your Brain
                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                          • Slide 146
                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                          • Slide 149
                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                          • Slide 152
                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                          • Slide 154
                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                          • Slide 157
                                                                                                                          • Slide 158
                                                                                                                          • Slide 159
                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                          • Slide 162
                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                          • Slide 164
                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                          • Slide 166
                                                                                                                          • Slide 167
                                                                                                                          • Slide 168
                                                                                                                          • Slide 169
                                                                                                                          • Slide 170
                                                                                                                          • Self-Talk Proficiency
                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                          • Match the Picture
                                                                                                                          • Slide 176
                                                                                                                          • Slide 177
                                                                                                                          • Distraction Delay Training
                                                                                                                          • Slide 179
                                                                                                                          • Slide 180
                                                                                                                          • Executive Estimates Training
                                                                                                                          • Learning Time
                                                                                                                          • Learning Time (2)
                                                                                                                          • Learning Time (3)
                                                                                                                          • Slide 185
                                                                                                                          • Slide 186
                                                                                                                          • Learning Time (4)
                                                                                                                          • Asking two questionshellip
                                                                                                                          • Slide 189
                                                                                                                          • Slide 190
                                                                                                                          • Key Features of Video Games
                                                                                                                          • Key Features of Video Games (2)
                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                          • Slide 194
                                                                                                                          • Slide 195
                                                                                                                          • Slide 196
                                                                                                                          • Slide 197
                                                                                                                          • Slide 198
                                                                                                                          • Slide 199
                                                                                                                          • Slide 200
                                                                                                                          • Slide 201
                                                                                                                          • Quarterly QI review
                                                                                                                          • The post-mortem
                                                                                                                          • Slide 204
                                                                                                                          • Slide 205
                                                                                                                          • Slide 206
                                                                                                                          • Slide 207
                                                                                                                          • Slide 208
                                                                                                                          • Slide 209
                                                                                                                          • Slide 210
                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                          • Slide 212
                                                                                                                          • Slide 213
                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                          • Slide 215
                                                                                                                          • Slide 216
                                                                                                                          • Slide 217
                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                          • A challengehellip
                                                                                                                          • Slide 222

                                                                                                                            Teenage ndash mid 20s Independent with assignments Make adjustments based on feedback Longer term goal setting Managing leisure time Inhibit reckless behavior Easily walk away from provocation Say ldquonordquo to fun activity if other plans

                                                                                                                            already made Take othersrsquo perspective

                                                                                                                            Age-appropriate expectations

                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                            Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                            Strategies

                                                                                                                            Pharmacotherapy

                                                                                                                            X

                                                                                                                            Behavioral Supports

                                                                                                                            A B C

                                                                                                                            A B C

                                                                                                                            behavior

                                                                                                                            A B C

                                                                                                                            consequences

                                                                                                                            A B C

                                                                                                                            antecedent

                                                                                                                            A B C

                                                                                                                            A B C

                                                                                                                            antecedent

                                                                                                                            A B C

                                                                                                                            antecedent

                                                                                                                            easy hard

                                                                                                                            A B C

                                                                                                                            consequences

                                                                                                                            R P

                                                                                                                            +

                                                                                                                            -

                                                                                                                            R+ P+

                                                                                                                            R- P-

                                                                                                                            Time Out

                                                                                                                            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                            Token economy

                                                                                                                            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                            Intrinsic motivation

                                                                                                                            A B C

                                                                                                                            consequencesX

                                                                                                                            A B C

                                                                                                                            behavior

                                                                                                                            Metacognition

                                                                                                                            Metacognitive knowledge Metacognitive strategies

                                                                                                                            ldquoLend Me Your Brainrdquo

                                                                                                                            What Does Dopamine Feel Like

                                                                                                                            The Physiology of Motivation and Reward

                                                                                                                            Preferred States What Does Dopamine Feel Like

                                                                                                                            1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                            David D Nowell PhD189 May Street

                                                                                                                            Worcester Mass 01602DrNowellcom

                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                            wwwLulucom

                                                                                                                            Identify 20 peak experiences For each peak experience identify the

                                                                                                                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                            of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                            clusters groupings There will probably be 4 or 5

                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                            Find a word a label for each of the groupings

                                                                                                                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                            ldquovaluesrdquo ways that you really like to feel

                                                                                                                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                            Broaden and Build

                                                                                                                            ldquoNeuroMalleabilityrdquo

                                                                                                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                            The reward-and-planning system

                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                            The reward-and-planning system

                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                            Lend Me Your Brain

                                                                                                                            Supporting Clients with Executive Dysfunction

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                            Too busy with current activity

                                                                                                                            Field dependent

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Sequence problem-solve

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Block out distractions

                                                                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                            - E Goldberg

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Get the reward

                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                            Instant gratification vs

                                                                                                                            executive gratification

                                                                                                                            A B C

                                                                                                                            behaviorx

                                                                                                                            Self-Talk Proficiency

                                                                                                                            Self-Talk Proficiency

                                                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                            takerdquordquo

                                                                                                                            Self-Talk Proficiency

                                                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                                                            Self-Talk Proficiency

                                                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                            thathelliprdquo

                                                                                                                            Match the Picture

                                                                                                                            Distraction Delay Training

                                                                                                                            Executive Estimates Training

                                                                                                                            X

                                                                                                                            Learning Time

                                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                            Learning Time

                                                                                                                            Learning Time

                                                                                                                            Learning Time

                                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                            Asking two questionshellip

                                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                                            Am I having fun nowIs

                                                                                                                            this

                                                                                                                            what

                                                                                                                            I se

                                                                                                                            t out

                                                                                                                            to

                                                                                                                            do

                                                                                                                            bullYesbullYes

                                                                                                                            bullNobullYes

                                                                                                                            bullYesbullNo

                                                                                                                            bullNobullNo

                                                                                                                            Am I having fun nowIs

                                                                                                                            this

                                                                                                                            what

                                                                                                                            I se

                                                                                                                            t out

                                                                                                                            to

                                                                                                                            do

                                                                                                                            bullFunbullOn-task

                                                                                                                            bullNot funbullOn-task

                                                                                                                            bullFunbullNot on-task

                                                                                                                            bullNot funbullNot on-task

                                                                                                                            Key Features of Video Games

                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                            Key Features of Video Games

                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                            Volkow et al 2004

                                                                                                                            Increase salience

                                                                                                                            Increase salience

                                                                                                                            Quarterly QI review

                                                                                                                            The post-mortem

                                                                                                                            Your 1 Organizational Tool

                                                                                                                            Your 1 Organizational Tool

                                                                                                                            Yoga read

                                                                                                                            Staff meeting

                                                                                                                            Planningsession

                                                                                                                            Phone calls

                                                                                                                            billing

                                                                                                                            Your 1 Organizational Tool

                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                            Your 1 Organizational Tool

                                                                                                                            Learn French

                                                                                                                            Stop smoking

                                                                                                                            Be a better spouse

                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                            A CHALLENGEhellip

                                                                                                                            wwwDrNowellcom

                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                            DavidNowellSeminars

                                                                                                                            DavidNowell

                                                                                                                            • Slide 1
                                                                                                                            • hellipa challenge
                                                                                                                            • Slide 3
                                                                                                                            • Perspective of this workshophellip
                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                            • Slide 7
                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                            • Overview
                                                                                                                            • This Dense Pudding
                                                                                                                            • Sensory Processing Disorder
                                                                                                                            • Slide 12
                                                                                                                            • Slide 13
                                                                                                                            • Developmental considerations
                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                            • Slide 17
                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                            • Slide 19
                                                                                                                            • Strategies
                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                            • Slide 22
                                                                                                                            • Slide 23
                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                            • Slide 25
                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                            • Slide 27
                                                                                                                            • Slide 28
                                                                                                                            • Slide 29
                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                            • CAPD or ADHD
                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                            • Slide 35
                                                                                                                            • Strategies (2)
                                                                                                                            • (C)APD
                                                                                                                            • Treatment for CAPD
                                                                                                                            • Treatment for CAPD (2)
                                                                                                                            • Self-assessment
                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                            • Slide 42
                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                            • (85 ndash X) x 365
                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                            • Core symptoms
                                                                                                                            • Core symptoms (2)
                                                                                                                            • hellipand the rest of the criteria
                                                                                                                            • Slide 49
                                                                                                                            • Functional impact of core symptoms
                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                            • Slide 53
                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                            • Subtypes of ADHD
                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                            • Common comorbidities with ADHD
                                                                                                                            • Slide 63
                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                            • ADHD and girls
                                                                                                                            • Slide 66
                                                                                                                            • Slide 67
                                                                                                                            • ADHD and women
                                                                                                                            • Slide 69
                                                                                                                            • ADHD and women (2)
                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                            • The Executive Functions
                                                                                                                            • The Executive Functions (2)
                                                                                                                            • Slide 74
                                                                                                                            • Slide 75
                                                                                                                            • Appropriate expectations
                                                                                                                            • Age-appropriate expectations
                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                            • Slide 84
                                                                                                                            • Slide 85
                                                                                                                            • Strategies (3)
                                                                                                                            • Pharmacotherapy
                                                                                                                            • Behavioral Supports
                                                                                                                            • Slide 89
                                                                                                                            • Slide 90
                                                                                                                            • Slide 91
                                                                                                                            • Slide 92
                                                                                                                            • Slide 93
                                                                                                                            • Slide 94
                                                                                                                            • Slide 95
                                                                                                                            • Slide 96
                                                                                                                            • Slide 97
                                                                                                                            • Slide 98
                                                                                                                            • Slide 99
                                                                                                                            • Slide 100
                                                                                                                            • Slide 101
                                                                                                                            • Slide 102
                                                                                                                            • Slide 103
                                                                                                                            • Slide 104
                                                                                                                            • Slide 105
                                                                                                                            • Slide 106
                                                                                                                            • Slide 107
                                                                                                                            • Slide 108
                                                                                                                            • Slide 109
                                                                                                                            • Slide 110
                                                                                                                            • Time Out
                                                                                                                            • Token economy
                                                                                                                            • Slide 113
                                                                                                                            • Slide 114
                                                                                                                            • Slide 115
                                                                                                                            • Intrinsic motivation
                                                                                                                            • Slide 117
                                                                                                                            • Slide 118
                                                                                                                            • Slide 119
                                                                                                                            • Metacognition
                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                            • Slide 124
                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                            • Slide 128
                                                                                                                            • Slide 129
                                                                                                                            • Broaden and Build
                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                            • The reward-and-planning system
                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                            • The reward-and-planning system (2)
                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                            • Slide 141
                                                                                                                            • Lend Me Your Brain
                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                            • Slide 146
                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                            • Slide 149
                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                            • Slide 152
                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                            • Slide 154
                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                            • Slide 157
                                                                                                                            • Slide 158
                                                                                                                            • Slide 159
                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                            • Slide 162
                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                            • Slide 164
                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                            • Slide 166
                                                                                                                            • Slide 167
                                                                                                                            • Slide 168
                                                                                                                            • Slide 169
                                                                                                                            • Slide 170
                                                                                                                            • Self-Talk Proficiency
                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                            • Match the Picture
                                                                                                                            • Slide 176
                                                                                                                            • Slide 177
                                                                                                                            • Distraction Delay Training
                                                                                                                            • Slide 179
                                                                                                                            • Slide 180
                                                                                                                            • Executive Estimates Training
                                                                                                                            • Learning Time
                                                                                                                            • Learning Time (2)
                                                                                                                            • Learning Time (3)
                                                                                                                            • Slide 185
                                                                                                                            • Slide 186
                                                                                                                            • Learning Time (4)
                                                                                                                            • Asking two questionshellip
                                                                                                                            • Slide 189
                                                                                                                            • Slide 190
                                                                                                                            • Key Features of Video Games
                                                                                                                            • Key Features of Video Games (2)
                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                            • Slide 194
                                                                                                                            • Slide 195
                                                                                                                            • Slide 196
                                                                                                                            • Slide 197
                                                                                                                            • Slide 198
                                                                                                                            • Slide 199
                                                                                                                            • Slide 200
                                                                                                                            • Slide 201
                                                                                                                            • Quarterly QI review
                                                                                                                            • The post-mortem
                                                                                                                            • Slide 204
                                                                                                                            • Slide 205
                                                                                                                            • Slide 206
                                                                                                                            • Slide 207
                                                                                                                            • Slide 208
                                                                                                                            • Slide 209
                                                                                                                            • Slide 210
                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                            • Slide 212
                                                                                                                            • Slide 213
                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                            • Slide 215
                                                                                                                            • Slide 216
                                                                                                                            • Slide 217
                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                            • A challengehellip
                                                                                                                            • Slide 222

                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                              Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                              Strategies

                                                                                                                              Pharmacotherapy

                                                                                                                              X

                                                                                                                              Behavioral Supports

                                                                                                                              A B C

                                                                                                                              A B C

                                                                                                                              behavior

                                                                                                                              A B C

                                                                                                                              consequences

                                                                                                                              A B C

                                                                                                                              antecedent

                                                                                                                              A B C

                                                                                                                              A B C

                                                                                                                              antecedent

                                                                                                                              A B C

                                                                                                                              antecedent

                                                                                                                              easy hard

                                                                                                                              A B C

                                                                                                                              consequences

                                                                                                                              R P

                                                                                                                              +

                                                                                                                              -

                                                                                                                              R+ P+

                                                                                                                              R- P-

                                                                                                                              Time Out

                                                                                                                              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                              Token economy

                                                                                                                              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                              Intrinsic motivation

                                                                                                                              A B C

                                                                                                                              consequencesX

                                                                                                                              A B C

                                                                                                                              behavior

                                                                                                                              Metacognition

                                                                                                                              Metacognitive knowledge Metacognitive strategies

                                                                                                                              ldquoLend Me Your Brainrdquo

                                                                                                                              What Does Dopamine Feel Like

                                                                                                                              The Physiology of Motivation and Reward

                                                                                                                              Preferred States What Does Dopamine Feel Like

                                                                                                                              1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                              David D Nowell PhD189 May Street

                                                                                                                              Worcester Mass 01602DrNowellcom

                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                              wwwLulucom

                                                                                                                              Identify 20 peak experiences For each peak experience identify the

                                                                                                                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                              of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                              clusters groupings There will probably be 4 or 5

                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                              Find a word a label for each of the groupings

                                                                                                                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                              ldquovaluesrdquo ways that you really like to feel

                                                                                                                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                              Broaden and Build

                                                                                                                              ldquoNeuroMalleabilityrdquo

                                                                                                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                              The reward-and-planning system

                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                              The reward-and-planning system

                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                              Lend Me Your Brain

                                                                                                                              Supporting Clients with Executive Dysfunction

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                              Too busy with current activity

                                                                                                                              Field dependent

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Sequence problem-solve

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Block out distractions

                                                                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                              - E Goldberg

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Get the reward

                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                              Instant gratification vs

                                                                                                                              executive gratification

                                                                                                                              A B C

                                                                                                                              behaviorx

                                                                                                                              Self-Talk Proficiency

                                                                                                                              Self-Talk Proficiency

                                                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                              takerdquordquo

                                                                                                                              Self-Talk Proficiency

                                                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                                                              Self-Talk Proficiency

                                                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                              thathelliprdquo

                                                                                                                              Match the Picture

                                                                                                                              Distraction Delay Training

                                                                                                                              Executive Estimates Training

                                                                                                                              X

                                                                                                                              Learning Time

                                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                              Learning Time

                                                                                                                              Learning Time

                                                                                                                              Learning Time

                                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                              Asking two questionshellip

                                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                                              Am I having fun nowIs

                                                                                                                              this

                                                                                                                              what

                                                                                                                              I se

                                                                                                                              t out

                                                                                                                              to

                                                                                                                              do

                                                                                                                              bullYesbullYes

                                                                                                                              bullNobullYes

                                                                                                                              bullYesbullNo

                                                                                                                              bullNobullNo

                                                                                                                              Am I having fun nowIs

                                                                                                                              this

                                                                                                                              what

                                                                                                                              I se

                                                                                                                              t out

                                                                                                                              to

                                                                                                                              do

                                                                                                                              bullFunbullOn-task

                                                                                                                              bullNot funbullOn-task

                                                                                                                              bullFunbullNot on-task

                                                                                                                              bullNot funbullNot on-task

                                                                                                                              Key Features of Video Games

                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                              Key Features of Video Games

                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                              Volkow et al 2004

                                                                                                                              Increase salience

                                                                                                                              Increase salience

                                                                                                                              Quarterly QI review

                                                                                                                              The post-mortem

                                                                                                                              Your 1 Organizational Tool

                                                                                                                              Your 1 Organizational Tool

                                                                                                                              Yoga read

                                                                                                                              Staff meeting

                                                                                                                              Planningsession

                                                                                                                              Phone calls

                                                                                                                              billing

                                                                                                                              Your 1 Organizational Tool

                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                              Your 1 Organizational Tool

                                                                                                                              Learn French

                                                                                                                              Stop smoking

                                                                                                                              Be a better spouse

                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                              A CHALLENGEhellip

                                                                                                                              wwwDrNowellcom

                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                              DavidNowellSeminars

                                                                                                                              DavidNowell

                                                                                                                              • Slide 1
                                                                                                                              • hellipa challenge
                                                                                                                              • Slide 3
                                                                                                                              • Perspective of this workshophellip
                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                              • Slide 7
                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                              • Overview
                                                                                                                              • This Dense Pudding
                                                                                                                              • Sensory Processing Disorder
                                                                                                                              • Slide 12
                                                                                                                              • Slide 13
                                                                                                                              • Developmental considerations
                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                              • Slide 17
                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                              • Slide 19
                                                                                                                              • Strategies
                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                              • Slide 22
                                                                                                                              • Slide 23
                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                              • Slide 25
                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                              • Slide 27
                                                                                                                              • Slide 28
                                                                                                                              • Slide 29
                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                              • CAPD or ADHD
                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                              • Slide 35
                                                                                                                              • Strategies (2)
                                                                                                                              • (C)APD
                                                                                                                              • Treatment for CAPD
                                                                                                                              • Treatment for CAPD (2)
                                                                                                                              • Self-assessment
                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                              • Slide 42
                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                              • (85 ndash X) x 365
                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                              • Core symptoms
                                                                                                                              • Core symptoms (2)
                                                                                                                              • hellipand the rest of the criteria
                                                                                                                              • Slide 49
                                                                                                                              • Functional impact of core symptoms
                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                              • Slide 53
                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                              • Subtypes of ADHD
                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                              • Common comorbidities with ADHD
                                                                                                                              • Slide 63
                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                              • ADHD and girls
                                                                                                                              • Slide 66
                                                                                                                              • Slide 67
                                                                                                                              • ADHD and women
                                                                                                                              • Slide 69
                                                                                                                              • ADHD and women (2)
                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                              • The Executive Functions
                                                                                                                              • The Executive Functions (2)
                                                                                                                              • Slide 74
                                                                                                                              • Slide 75
                                                                                                                              • Appropriate expectations
                                                                                                                              • Age-appropriate expectations
                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                              • Slide 84
                                                                                                                              • Slide 85
                                                                                                                              • Strategies (3)
                                                                                                                              • Pharmacotherapy
                                                                                                                              • Behavioral Supports
                                                                                                                              • Slide 89
                                                                                                                              • Slide 90
                                                                                                                              • Slide 91
                                                                                                                              • Slide 92
                                                                                                                              • Slide 93
                                                                                                                              • Slide 94
                                                                                                                              • Slide 95
                                                                                                                              • Slide 96
                                                                                                                              • Slide 97
                                                                                                                              • Slide 98
                                                                                                                              • Slide 99
                                                                                                                              • Slide 100
                                                                                                                              • Slide 101
                                                                                                                              • Slide 102
                                                                                                                              • Slide 103
                                                                                                                              • Slide 104
                                                                                                                              • Slide 105
                                                                                                                              • Slide 106
                                                                                                                              • Slide 107
                                                                                                                              • Slide 108
                                                                                                                              • Slide 109
                                                                                                                              • Slide 110
                                                                                                                              • Time Out
                                                                                                                              • Token economy
                                                                                                                              • Slide 113
                                                                                                                              • Slide 114
                                                                                                                              • Slide 115
                                                                                                                              • Intrinsic motivation
                                                                                                                              • Slide 117
                                                                                                                              • Slide 118
                                                                                                                              • Slide 119
                                                                                                                              • Metacognition
                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                              • Slide 124
                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                              • Slide 128
                                                                                                                              • Slide 129
                                                                                                                              • Broaden and Build
                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                              • The reward-and-planning system
                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                              • The reward-and-planning system (2)
                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                              • Slide 141
                                                                                                                              • Lend Me Your Brain
                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                              • Slide 146
                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                              • Slide 149
                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                              • Slide 152
                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                              • Slide 154
                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                              • Slide 157
                                                                                                                              • Slide 158
                                                                                                                              • Slide 159
                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                              • Slide 162
                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                              • Slide 164
                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                              • Slide 166
                                                                                                                              • Slide 167
                                                                                                                              • Slide 168
                                                                                                                              • Slide 169
                                                                                                                              • Slide 170
                                                                                                                              • Self-Talk Proficiency
                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                              • Match the Picture
                                                                                                                              • Slide 176
                                                                                                                              • Slide 177
                                                                                                                              • Distraction Delay Training
                                                                                                                              • Slide 179
                                                                                                                              • Slide 180
                                                                                                                              • Executive Estimates Training
                                                                                                                              • Learning Time
                                                                                                                              • Learning Time (2)
                                                                                                                              • Learning Time (3)
                                                                                                                              • Slide 185
                                                                                                                              • Slide 186
                                                                                                                              • Learning Time (4)
                                                                                                                              • Asking two questionshellip
                                                                                                                              • Slide 189
                                                                                                                              • Slide 190
                                                                                                                              • Key Features of Video Games
                                                                                                                              • Key Features of Video Games (2)
                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                              • Slide 194
                                                                                                                              • Slide 195
                                                                                                                              • Slide 196
                                                                                                                              • Slide 197
                                                                                                                              • Slide 198
                                                                                                                              • Slide 199
                                                                                                                              • Slide 200
                                                                                                                              • Slide 201
                                                                                                                              • Quarterly QI review
                                                                                                                              • The post-mortem
                                                                                                                              • Slide 204
                                                                                                                              • Slide 205
                                                                                                                              • Slide 206
                                                                                                                              • Slide 207
                                                                                                                              • Slide 208
                                                                                                                              • Slide 209
                                                                                                                              • Slide 210
                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                              • Slide 212
                                                                                                                              • Slide 213
                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                              • Slide 215
                                                                                                                              • Slide 216
                                                                                                                              • Slide 217
                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                              • A challengehellip
                                                                                                                              • Slide 222

                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                                Strategies

                                                                                                                                Pharmacotherapy

                                                                                                                                X

                                                                                                                                Behavioral Supports

                                                                                                                                A B C

                                                                                                                                A B C

                                                                                                                                behavior

                                                                                                                                A B C

                                                                                                                                consequences

                                                                                                                                A B C

                                                                                                                                antecedent

                                                                                                                                A B C

                                                                                                                                A B C

                                                                                                                                antecedent

                                                                                                                                A B C

                                                                                                                                antecedent

                                                                                                                                easy hard

                                                                                                                                A B C

                                                                                                                                consequences

                                                                                                                                R P

                                                                                                                                +

                                                                                                                                -

                                                                                                                                R+ P+

                                                                                                                                R- P-

                                                                                                                                Time Out

                                                                                                                                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                Token economy

                                                                                                                                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                Intrinsic motivation

                                                                                                                                A B C

                                                                                                                                consequencesX

                                                                                                                                A B C

                                                                                                                                behavior

                                                                                                                                Metacognition

                                                                                                                                Metacognitive knowledge Metacognitive strategies

                                                                                                                                ldquoLend Me Your Brainrdquo

                                                                                                                                What Does Dopamine Feel Like

                                                                                                                                The Physiology of Motivation and Reward

                                                                                                                                Preferred States What Does Dopamine Feel Like

                                                                                                                                1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                David D Nowell PhD189 May Street

                                                                                                                                Worcester Mass 01602DrNowellcom

                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                wwwLulucom

                                                                                                                                Identify 20 peak experiences For each peak experience identify the

                                                                                                                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                clusters groupings There will probably be 4 or 5

                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                Find a word a label for each of the groupings

                                                                                                                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                ldquovaluesrdquo ways that you really like to feel

                                                                                                                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                Broaden and Build

                                                                                                                                ldquoNeuroMalleabilityrdquo

                                                                                                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                The reward-and-planning system

                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                The reward-and-planning system

                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                Lend Me Your Brain

                                                                                                                                Supporting Clients with Executive Dysfunction

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                Too busy with current activity

                                                                                                                                Field dependent

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Sequence problem-solve

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Block out distractions

                                                                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                - E Goldberg

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Get the reward

                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                Instant gratification vs

                                                                                                                                executive gratification

                                                                                                                                A B C

                                                                                                                                behaviorx

                                                                                                                                Self-Talk Proficiency

                                                                                                                                Self-Talk Proficiency

                                                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                takerdquordquo

                                                                                                                                Self-Talk Proficiency

                                                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                                                Self-Talk Proficiency

                                                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                thathelliprdquo

                                                                                                                                Match the Picture

                                                                                                                                Distraction Delay Training

                                                                                                                                Executive Estimates Training

                                                                                                                                X

                                                                                                                                Learning Time

                                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                Learning Time

                                                                                                                                Learning Time

                                                                                                                                Learning Time

                                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                Asking two questionshellip

                                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                                Am I having fun nowIs

                                                                                                                                this

                                                                                                                                what

                                                                                                                                I se

                                                                                                                                t out

                                                                                                                                to

                                                                                                                                do

                                                                                                                                bullYesbullYes

                                                                                                                                bullNobullYes

                                                                                                                                bullYesbullNo

                                                                                                                                bullNobullNo

                                                                                                                                Am I having fun nowIs

                                                                                                                                this

                                                                                                                                what

                                                                                                                                I se

                                                                                                                                t out

                                                                                                                                to

                                                                                                                                do

                                                                                                                                bullFunbullOn-task

                                                                                                                                bullNot funbullOn-task

                                                                                                                                bullFunbullNot on-task

                                                                                                                                bullNot funbullNot on-task

                                                                                                                                Key Features of Video Games

                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                Key Features of Video Games

                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                Volkow et al 2004

                                                                                                                                Increase salience

                                                                                                                                Increase salience

                                                                                                                                Quarterly QI review

                                                                                                                                The post-mortem

                                                                                                                                Your 1 Organizational Tool

                                                                                                                                Your 1 Organizational Tool

                                                                                                                                Yoga read

                                                                                                                                Staff meeting

                                                                                                                                Planningsession

                                                                                                                                Phone calls

                                                                                                                                billing

                                                                                                                                Your 1 Organizational Tool

                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                Your 1 Organizational Tool

                                                                                                                                Learn French

                                                                                                                                Stop smoking

                                                                                                                                Be a better spouse

                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                A CHALLENGEhellip

                                                                                                                                wwwDrNowellcom

                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                DavidNowellSeminars

                                                                                                                                DavidNowell

                                                                                                                                • Slide 1
                                                                                                                                • hellipa challenge
                                                                                                                                • Slide 3
                                                                                                                                • Perspective of this workshophellip
                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                • Slide 7
                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                • Overview
                                                                                                                                • This Dense Pudding
                                                                                                                                • Sensory Processing Disorder
                                                                                                                                • Slide 12
                                                                                                                                • Slide 13
                                                                                                                                • Developmental considerations
                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                • Slide 17
                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                • Slide 19
                                                                                                                                • Strategies
                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                • Slide 22
                                                                                                                                • Slide 23
                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                • Slide 25
                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                • Slide 27
                                                                                                                                • Slide 28
                                                                                                                                • Slide 29
                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                • CAPD or ADHD
                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                • Slide 35
                                                                                                                                • Strategies (2)
                                                                                                                                • (C)APD
                                                                                                                                • Treatment for CAPD
                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                • Self-assessment
                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                • Slide 42
                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                • (85 ndash X) x 365
                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                • Core symptoms
                                                                                                                                • Core symptoms (2)
                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                • Slide 49
                                                                                                                                • Functional impact of core symptoms
                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                • Slide 53
                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                • Subtypes of ADHD
                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                • Slide 63
                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                • ADHD and girls
                                                                                                                                • Slide 66
                                                                                                                                • Slide 67
                                                                                                                                • ADHD and women
                                                                                                                                • Slide 69
                                                                                                                                • ADHD and women (2)
                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                • The Executive Functions
                                                                                                                                • The Executive Functions (2)
                                                                                                                                • Slide 74
                                                                                                                                • Slide 75
                                                                                                                                • Appropriate expectations
                                                                                                                                • Age-appropriate expectations
                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                • Slide 84
                                                                                                                                • Slide 85
                                                                                                                                • Strategies (3)
                                                                                                                                • Pharmacotherapy
                                                                                                                                • Behavioral Supports
                                                                                                                                • Slide 89
                                                                                                                                • Slide 90
                                                                                                                                • Slide 91
                                                                                                                                • Slide 92
                                                                                                                                • Slide 93
                                                                                                                                • Slide 94
                                                                                                                                • Slide 95
                                                                                                                                • Slide 96
                                                                                                                                • Slide 97
                                                                                                                                • Slide 98
                                                                                                                                • Slide 99
                                                                                                                                • Slide 100
                                                                                                                                • Slide 101
                                                                                                                                • Slide 102
                                                                                                                                • Slide 103
                                                                                                                                • Slide 104
                                                                                                                                • Slide 105
                                                                                                                                • Slide 106
                                                                                                                                • Slide 107
                                                                                                                                • Slide 108
                                                                                                                                • Slide 109
                                                                                                                                • Slide 110
                                                                                                                                • Time Out
                                                                                                                                • Token economy
                                                                                                                                • Slide 113
                                                                                                                                • Slide 114
                                                                                                                                • Slide 115
                                                                                                                                • Intrinsic motivation
                                                                                                                                • Slide 117
                                                                                                                                • Slide 118
                                                                                                                                • Slide 119
                                                                                                                                • Metacognition
                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                • Slide 124
                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                • Slide 128
                                                                                                                                • Slide 129
                                                                                                                                • Broaden and Build
                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                • The reward-and-planning system
                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                • Slide 141
                                                                                                                                • Lend Me Your Brain
                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                • Slide 146
                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                • Slide 149
                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                • Slide 152
                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                • Slide 154
                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                • Slide 157
                                                                                                                                • Slide 158
                                                                                                                                • Slide 159
                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                • Slide 162
                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                • Slide 164
                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                • Slide 166
                                                                                                                                • Slide 167
                                                                                                                                • Slide 168
                                                                                                                                • Slide 169
                                                                                                                                • Slide 170
                                                                                                                                • Self-Talk Proficiency
                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                • Match the Picture
                                                                                                                                • Slide 176
                                                                                                                                • Slide 177
                                                                                                                                • Distraction Delay Training
                                                                                                                                • Slide 179
                                                                                                                                • Slide 180
                                                                                                                                • Executive Estimates Training
                                                                                                                                • Learning Time
                                                                                                                                • Learning Time (2)
                                                                                                                                • Learning Time (3)
                                                                                                                                • Slide 185
                                                                                                                                • Slide 186
                                                                                                                                • Learning Time (4)
                                                                                                                                • Asking two questionshellip
                                                                                                                                • Slide 189
                                                                                                                                • Slide 190
                                                                                                                                • Key Features of Video Games
                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                • Slide 194
                                                                                                                                • Slide 195
                                                                                                                                • Slide 196
                                                                                                                                • Slide 197
                                                                                                                                • Slide 198
                                                                                                                                • Slide 199
                                                                                                                                • Slide 200
                                                                                                                                • Slide 201
                                                                                                                                • Quarterly QI review
                                                                                                                                • The post-mortem
                                                                                                                                • Slide 204
                                                                                                                                • Slide 205
                                                                                                                                • Slide 206
                                                                                                                                • Slide 207
                                                                                                                                • Slide 208
                                                                                                                                • Slide 209
                                                                                                                                • Slide 210
                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                • Slide 212
                                                                                                                                • Slide 213
                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                • Slide 215
                                                                                                                                • Slide 216
                                                                                                                                • Slide 217
                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                • A challengehellip
                                                                                                                                • Slide 222

                                                                                                                                  Inter-connectedness of systems Cortico-striatal system for example

                                                                                                                                  Strategies

                                                                                                                                  Pharmacotherapy

                                                                                                                                  X

                                                                                                                                  Behavioral Supports

                                                                                                                                  A B C

                                                                                                                                  A B C

                                                                                                                                  behavior

                                                                                                                                  A B C

                                                                                                                                  consequences

                                                                                                                                  A B C

                                                                                                                                  antecedent

                                                                                                                                  A B C

                                                                                                                                  A B C

                                                                                                                                  antecedent

                                                                                                                                  A B C

                                                                                                                                  antecedent

                                                                                                                                  easy hard

                                                                                                                                  A B C

                                                                                                                                  consequences

                                                                                                                                  R P

                                                                                                                                  +

                                                                                                                                  -

                                                                                                                                  R+ P+

                                                                                                                                  R- P-

                                                                                                                                  Time Out

                                                                                                                                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                  Token economy

                                                                                                                                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                  Intrinsic motivation

                                                                                                                                  A B C

                                                                                                                                  consequencesX

                                                                                                                                  A B C

                                                                                                                                  behavior

                                                                                                                                  Metacognition

                                                                                                                                  Metacognitive knowledge Metacognitive strategies

                                                                                                                                  ldquoLend Me Your Brainrdquo

                                                                                                                                  What Does Dopamine Feel Like

                                                                                                                                  The Physiology of Motivation and Reward

                                                                                                                                  Preferred States What Does Dopamine Feel Like

                                                                                                                                  1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                  David D Nowell PhD189 May Street

                                                                                                                                  Worcester Mass 01602DrNowellcom

                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                  wwwLulucom

                                                                                                                                  Identify 20 peak experiences For each peak experience identify the

                                                                                                                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                  of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                  clusters groupings There will probably be 4 or 5

                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                  Find a word a label for each of the groupings

                                                                                                                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                  ldquovaluesrdquo ways that you really like to feel

                                                                                                                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                  Broaden and Build

                                                                                                                                  ldquoNeuroMalleabilityrdquo

                                                                                                                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                  The reward-and-planning system

                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                  The reward-and-planning system

                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                  Lend Me Your Brain

                                                                                                                                  Supporting Clients with Executive Dysfunction

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                  Too busy with current activity

                                                                                                                                  Field dependent

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Sequence problem-solve

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Block out distractions

                                                                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                  - E Goldberg

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Get the reward

                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                  Instant gratification vs

                                                                                                                                  executive gratification

                                                                                                                                  A B C

                                                                                                                                  behaviorx

                                                                                                                                  Self-Talk Proficiency

                                                                                                                                  Self-Talk Proficiency

                                                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                  takerdquordquo

                                                                                                                                  Self-Talk Proficiency

                                                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                                                  Self-Talk Proficiency

                                                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                  thathelliprdquo

                                                                                                                                  Match the Picture

                                                                                                                                  Distraction Delay Training

                                                                                                                                  Executive Estimates Training

                                                                                                                                  X

                                                                                                                                  Learning Time

                                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                  Learning Time

                                                                                                                                  Learning Time

                                                                                                                                  Learning Time

                                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                  Asking two questionshellip

                                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                                  Am I having fun nowIs

                                                                                                                                  this

                                                                                                                                  what

                                                                                                                                  I se

                                                                                                                                  t out

                                                                                                                                  to

                                                                                                                                  do

                                                                                                                                  bullYesbullYes

                                                                                                                                  bullNobullYes

                                                                                                                                  bullYesbullNo

                                                                                                                                  bullNobullNo

                                                                                                                                  Am I having fun nowIs

                                                                                                                                  this

                                                                                                                                  what

                                                                                                                                  I se

                                                                                                                                  t out

                                                                                                                                  to

                                                                                                                                  do

                                                                                                                                  bullFunbullOn-task

                                                                                                                                  bullNot funbullOn-task

                                                                                                                                  bullFunbullNot on-task

                                                                                                                                  bullNot funbullNot on-task

                                                                                                                                  Key Features of Video Games

                                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                                  Key Features of Video Games

                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                  Volkow et al 2004

                                                                                                                                  Increase salience

                                                                                                                                  Increase salience

                                                                                                                                  Quarterly QI review

                                                                                                                                  The post-mortem

                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                  Yoga read

                                                                                                                                  Staff meeting

                                                                                                                                  Planningsession

                                                                                                                                  Phone calls

                                                                                                                                  billing

                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                  Learn French

                                                                                                                                  Stop smoking

                                                                                                                                  Be a better spouse

                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                  A CHALLENGEhellip

                                                                                                                                  wwwDrNowellcom

                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                  DavidNowellSeminars

                                                                                                                                  DavidNowell

                                                                                                                                  • Slide 1
                                                                                                                                  • hellipa challenge
                                                                                                                                  • Slide 3
                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                  • Slide 7
                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                  • Overview
                                                                                                                                  • This Dense Pudding
                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                  • Slide 12
                                                                                                                                  • Slide 13
                                                                                                                                  • Developmental considerations
                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                  • Slide 17
                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                  • Slide 19
                                                                                                                                  • Strategies
                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                  • Slide 22
                                                                                                                                  • Slide 23
                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                  • Slide 25
                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                  • Slide 27
                                                                                                                                  • Slide 28
                                                                                                                                  • Slide 29
                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                  • CAPD or ADHD
                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                  • Slide 35
                                                                                                                                  • Strategies (2)
                                                                                                                                  • (C)APD
                                                                                                                                  • Treatment for CAPD
                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                  • Self-assessment
                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                  • Slide 42
                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                  • Core symptoms
                                                                                                                                  • Core symptoms (2)
                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                  • Slide 49
                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                  • Slide 53
                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                  • Subtypes of ADHD
                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                  • Slide 63
                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                  • ADHD and girls
                                                                                                                                  • Slide 66
                                                                                                                                  • Slide 67
                                                                                                                                  • ADHD and women
                                                                                                                                  • Slide 69
                                                                                                                                  • ADHD and women (2)
                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                  • The Executive Functions
                                                                                                                                  • The Executive Functions (2)
                                                                                                                                  • Slide 74
                                                                                                                                  • Slide 75
                                                                                                                                  • Appropriate expectations
                                                                                                                                  • Age-appropriate expectations
                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                  • Slide 84
                                                                                                                                  • Slide 85
                                                                                                                                  • Strategies (3)
                                                                                                                                  • Pharmacotherapy
                                                                                                                                  • Behavioral Supports
                                                                                                                                  • Slide 89
                                                                                                                                  • Slide 90
                                                                                                                                  • Slide 91
                                                                                                                                  • Slide 92
                                                                                                                                  • Slide 93
                                                                                                                                  • Slide 94
                                                                                                                                  • Slide 95
                                                                                                                                  • Slide 96
                                                                                                                                  • Slide 97
                                                                                                                                  • Slide 98
                                                                                                                                  • Slide 99
                                                                                                                                  • Slide 100
                                                                                                                                  • Slide 101
                                                                                                                                  • Slide 102
                                                                                                                                  • Slide 103
                                                                                                                                  • Slide 104
                                                                                                                                  • Slide 105
                                                                                                                                  • Slide 106
                                                                                                                                  • Slide 107
                                                                                                                                  • Slide 108
                                                                                                                                  • Slide 109
                                                                                                                                  • Slide 110
                                                                                                                                  • Time Out
                                                                                                                                  • Token economy
                                                                                                                                  • Slide 113
                                                                                                                                  • Slide 114
                                                                                                                                  • Slide 115
                                                                                                                                  • Intrinsic motivation
                                                                                                                                  • Slide 117
                                                                                                                                  • Slide 118
                                                                                                                                  • Slide 119
                                                                                                                                  • Metacognition
                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                  • Slide 124
                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                  • Slide 128
                                                                                                                                  • Slide 129
                                                                                                                                  • Broaden and Build
                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                  • The reward-and-planning system
                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                  • Slide 141
                                                                                                                                  • Lend Me Your Brain
                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                  • Slide 146
                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                  • Slide 149
                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                  • Slide 152
                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                  • Slide 154
                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                  • Slide 157
                                                                                                                                  • Slide 158
                                                                                                                                  • Slide 159
                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                  • Slide 162
                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                  • Slide 164
                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                  • Slide 166
                                                                                                                                  • Slide 167
                                                                                                                                  • Slide 168
                                                                                                                                  • Slide 169
                                                                                                                                  • Slide 170
                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                  • Match the Picture
                                                                                                                                  • Slide 176
                                                                                                                                  • Slide 177
                                                                                                                                  • Distraction Delay Training
                                                                                                                                  • Slide 179
                                                                                                                                  • Slide 180
                                                                                                                                  • Executive Estimates Training
                                                                                                                                  • Learning Time
                                                                                                                                  • Learning Time (2)
                                                                                                                                  • Learning Time (3)
                                                                                                                                  • Slide 185
                                                                                                                                  • Slide 186
                                                                                                                                  • Learning Time (4)
                                                                                                                                  • Asking two questionshellip
                                                                                                                                  • Slide 189
                                                                                                                                  • Slide 190
                                                                                                                                  • Key Features of Video Games
                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                  • Slide 194
                                                                                                                                  • Slide 195
                                                                                                                                  • Slide 196
                                                                                                                                  • Slide 197
                                                                                                                                  • Slide 198
                                                                                                                                  • Slide 199
                                                                                                                                  • Slide 200
                                                                                                                                  • Slide 201
                                                                                                                                  • Quarterly QI review
                                                                                                                                  • The post-mortem
                                                                                                                                  • Slide 204
                                                                                                                                  • Slide 205
                                                                                                                                  • Slide 206
                                                                                                                                  • Slide 207
                                                                                                                                  • Slide 208
                                                                                                                                  • Slide 209
                                                                                                                                  • Slide 210
                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                  • Slide 212
                                                                                                                                  • Slide 213
                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                  • Slide 215
                                                                                                                                  • Slide 216
                                                                                                                                  • Slide 217
                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                  • A challengehellip
                                                                                                                                  • Slide 222

                                                                                                                                    Strategies

                                                                                                                                    Pharmacotherapy

                                                                                                                                    X

                                                                                                                                    Behavioral Supports

                                                                                                                                    A B C

                                                                                                                                    A B C

                                                                                                                                    behavior

                                                                                                                                    A B C

                                                                                                                                    consequences

                                                                                                                                    A B C

                                                                                                                                    antecedent

                                                                                                                                    A B C

                                                                                                                                    A B C

                                                                                                                                    antecedent

                                                                                                                                    A B C

                                                                                                                                    antecedent

                                                                                                                                    easy hard

                                                                                                                                    A B C

                                                                                                                                    consequences

                                                                                                                                    R P

                                                                                                                                    +

                                                                                                                                    -

                                                                                                                                    R+ P+

                                                                                                                                    R- P-

                                                                                                                                    Time Out

                                                                                                                                    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                    Token economy

                                                                                                                                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                    Intrinsic motivation

                                                                                                                                    A B C

                                                                                                                                    consequencesX

                                                                                                                                    A B C

                                                                                                                                    behavior

                                                                                                                                    Metacognition

                                                                                                                                    Metacognitive knowledge Metacognitive strategies

                                                                                                                                    ldquoLend Me Your Brainrdquo

                                                                                                                                    What Does Dopamine Feel Like

                                                                                                                                    The Physiology of Motivation and Reward

                                                                                                                                    Preferred States What Does Dopamine Feel Like

                                                                                                                                    1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                    David D Nowell PhD189 May Street

                                                                                                                                    Worcester Mass 01602DrNowellcom

                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                    wwwLulucom

                                                                                                                                    Identify 20 peak experiences For each peak experience identify the

                                                                                                                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                    of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                    clusters groupings There will probably be 4 or 5

                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                    Find a word a label for each of the groupings

                                                                                                                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                    ldquovaluesrdquo ways that you really like to feel

                                                                                                                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                    Broaden and Build

                                                                                                                                    ldquoNeuroMalleabilityrdquo

                                                                                                                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                    The reward-and-planning system

                                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                    The reward-and-planning system

                                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                    Lend Me Your Brain

                                                                                                                                    Supporting Clients with Executive Dysfunction

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                    Too busy with current activity

                                                                                                                                    Field dependent

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Sequence problem-solve

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Block out distractions

                                                                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                    - E Goldberg

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Get the reward

                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                    Instant gratification vs

                                                                                                                                    executive gratification

                                                                                                                                    A B C

                                                                                                                                    behaviorx

                                                                                                                                    Self-Talk Proficiency

                                                                                                                                    Self-Talk Proficiency

                                                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                    takerdquordquo

                                                                                                                                    Self-Talk Proficiency

                                                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                                                    Self-Talk Proficiency

                                                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                    thathelliprdquo

                                                                                                                                    Match the Picture

                                                                                                                                    Distraction Delay Training

                                                                                                                                    Executive Estimates Training

                                                                                                                                    X

                                                                                                                                    Learning Time

                                                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                    Learning Time

                                                                                                                                    Learning Time

                                                                                                                                    Learning Time

                                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                    Asking two questionshellip

                                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                                    Am I having fun nowIs

                                                                                                                                    this

                                                                                                                                    what

                                                                                                                                    I se

                                                                                                                                    t out

                                                                                                                                    to

                                                                                                                                    do

                                                                                                                                    bullYesbullYes

                                                                                                                                    bullNobullYes

                                                                                                                                    bullYesbullNo

                                                                                                                                    bullNobullNo

                                                                                                                                    Am I having fun nowIs

                                                                                                                                    this

                                                                                                                                    what

                                                                                                                                    I se

                                                                                                                                    t out

                                                                                                                                    to

                                                                                                                                    do

                                                                                                                                    bullFunbullOn-task

                                                                                                                                    bullNot funbullOn-task

                                                                                                                                    bullFunbullNot on-task

                                                                                                                                    bullNot funbullNot on-task

                                                                                                                                    Key Features of Video Games

                                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                                    Key Features of Video Games

                                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                    Volkow et al 2004

                                                                                                                                    Increase salience

                                                                                                                                    Increase salience

                                                                                                                                    Quarterly QI review

                                                                                                                                    The post-mortem

                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                    Yoga read

                                                                                                                                    Staff meeting

                                                                                                                                    Planningsession

                                                                                                                                    Phone calls

                                                                                                                                    billing

                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                    Learn French

                                                                                                                                    Stop smoking

                                                                                                                                    Be a better spouse

                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                    A CHALLENGEhellip

                                                                                                                                    wwwDrNowellcom

                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                    DavidNowellSeminars

                                                                                                                                    DavidNowell

                                                                                                                                    • Slide 1
                                                                                                                                    • hellipa challenge
                                                                                                                                    • Slide 3
                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                    • Slide 7
                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                    • Overview
                                                                                                                                    • This Dense Pudding
                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                    • Slide 12
                                                                                                                                    • Slide 13
                                                                                                                                    • Developmental considerations
                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                    • Slide 17
                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                    • Slide 19
                                                                                                                                    • Strategies
                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                    • Slide 22
                                                                                                                                    • Slide 23
                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                    • Slide 25
                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                    • Slide 27
                                                                                                                                    • Slide 28
                                                                                                                                    • Slide 29
                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                    • CAPD or ADHD
                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                    • Slide 35
                                                                                                                                    • Strategies (2)
                                                                                                                                    • (C)APD
                                                                                                                                    • Treatment for CAPD
                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                    • Self-assessment
                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                    • Slide 42
                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                    • Core symptoms
                                                                                                                                    • Core symptoms (2)
                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                    • Slide 49
                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                    • Slide 53
                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                    • Subtypes of ADHD
                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                    • Slide 63
                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                    • ADHD and girls
                                                                                                                                    • Slide 66
                                                                                                                                    • Slide 67
                                                                                                                                    • ADHD and women
                                                                                                                                    • Slide 69
                                                                                                                                    • ADHD and women (2)
                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                    • The Executive Functions
                                                                                                                                    • The Executive Functions (2)
                                                                                                                                    • Slide 74
                                                                                                                                    • Slide 75
                                                                                                                                    • Appropriate expectations
                                                                                                                                    • Age-appropriate expectations
                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                    • Slide 84
                                                                                                                                    • Slide 85
                                                                                                                                    • Strategies (3)
                                                                                                                                    • Pharmacotherapy
                                                                                                                                    • Behavioral Supports
                                                                                                                                    • Slide 89
                                                                                                                                    • Slide 90
                                                                                                                                    • Slide 91
                                                                                                                                    • Slide 92
                                                                                                                                    • Slide 93
                                                                                                                                    • Slide 94
                                                                                                                                    • Slide 95
                                                                                                                                    • Slide 96
                                                                                                                                    • Slide 97
                                                                                                                                    • Slide 98
                                                                                                                                    • Slide 99
                                                                                                                                    • Slide 100
                                                                                                                                    • Slide 101
                                                                                                                                    • Slide 102
                                                                                                                                    • Slide 103
                                                                                                                                    • Slide 104
                                                                                                                                    • Slide 105
                                                                                                                                    • Slide 106
                                                                                                                                    • Slide 107
                                                                                                                                    • Slide 108
                                                                                                                                    • Slide 109
                                                                                                                                    • Slide 110
                                                                                                                                    • Time Out
                                                                                                                                    • Token economy
                                                                                                                                    • Slide 113
                                                                                                                                    • Slide 114
                                                                                                                                    • Slide 115
                                                                                                                                    • Intrinsic motivation
                                                                                                                                    • Slide 117
                                                                                                                                    • Slide 118
                                                                                                                                    • Slide 119
                                                                                                                                    • Metacognition
                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                    • Slide 124
                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                    • Slide 128
                                                                                                                                    • Slide 129
                                                                                                                                    • Broaden and Build
                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                    • The reward-and-planning system
                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                    • Slide 141
                                                                                                                                    • Lend Me Your Brain
                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                    • Slide 146
                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                    • Slide 149
                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                    • Slide 152
                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                    • Slide 154
                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                    • Slide 157
                                                                                                                                    • Slide 158
                                                                                                                                    • Slide 159
                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                    • Slide 162
                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                    • Slide 164
                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                    • Slide 166
                                                                                                                                    • Slide 167
                                                                                                                                    • Slide 168
                                                                                                                                    • Slide 169
                                                                                                                                    • Slide 170
                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                    • Match the Picture
                                                                                                                                    • Slide 176
                                                                                                                                    • Slide 177
                                                                                                                                    • Distraction Delay Training
                                                                                                                                    • Slide 179
                                                                                                                                    • Slide 180
                                                                                                                                    • Executive Estimates Training
                                                                                                                                    • Learning Time
                                                                                                                                    • Learning Time (2)
                                                                                                                                    • Learning Time (3)
                                                                                                                                    • Slide 185
                                                                                                                                    • Slide 186
                                                                                                                                    • Learning Time (4)
                                                                                                                                    • Asking two questionshellip
                                                                                                                                    • Slide 189
                                                                                                                                    • Slide 190
                                                                                                                                    • Key Features of Video Games
                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                    • Slide 194
                                                                                                                                    • Slide 195
                                                                                                                                    • Slide 196
                                                                                                                                    • Slide 197
                                                                                                                                    • Slide 198
                                                                                                                                    • Slide 199
                                                                                                                                    • Slide 200
                                                                                                                                    • Slide 201
                                                                                                                                    • Quarterly QI review
                                                                                                                                    • The post-mortem
                                                                                                                                    • Slide 204
                                                                                                                                    • Slide 205
                                                                                                                                    • Slide 206
                                                                                                                                    • Slide 207
                                                                                                                                    • Slide 208
                                                                                                                                    • Slide 209
                                                                                                                                    • Slide 210
                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                    • Slide 212
                                                                                                                                    • Slide 213
                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                    • Slide 215
                                                                                                                                    • Slide 216
                                                                                                                                    • Slide 217
                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                    • A challengehellip
                                                                                                                                    • Slide 222

                                                                                                                                      Pharmacotherapy

                                                                                                                                      X

                                                                                                                                      Behavioral Supports

                                                                                                                                      A B C

                                                                                                                                      A B C

                                                                                                                                      behavior

                                                                                                                                      A B C

                                                                                                                                      consequences

                                                                                                                                      A B C

                                                                                                                                      antecedent

                                                                                                                                      A B C

                                                                                                                                      A B C

                                                                                                                                      antecedent

                                                                                                                                      A B C

                                                                                                                                      antecedent

                                                                                                                                      easy hard

                                                                                                                                      A B C

                                                                                                                                      consequences

                                                                                                                                      R P

                                                                                                                                      +

                                                                                                                                      -

                                                                                                                                      R+ P+

                                                                                                                                      R- P-

                                                                                                                                      Time Out

                                                                                                                                      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                      Token economy

                                                                                                                                      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                      Intrinsic motivation

                                                                                                                                      A B C

                                                                                                                                      consequencesX

                                                                                                                                      A B C

                                                                                                                                      behavior

                                                                                                                                      Metacognition

                                                                                                                                      Metacognitive knowledge Metacognitive strategies

                                                                                                                                      ldquoLend Me Your Brainrdquo

                                                                                                                                      What Does Dopamine Feel Like

                                                                                                                                      The Physiology of Motivation and Reward

                                                                                                                                      Preferred States What Does Dopamine Feel Like

                                                                                                                                      1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                      David D Nowell PhD189 May Street

                                                                                                                                      Worcester Mass 01602DrNowellcom

                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                      wwwLulucom

                                                                                                                                      Identify 20 peak experiences For each peak experience identify the

                                                                                                                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                      of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                      clusters groupings There will probably be 4 or 5

                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                      Find a word a label for each of the groupings

                                                                                                                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                      ldquovaluesrdquo ways that you really like to feel

                                                                                                                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                      Broaden and Build

                                                                                                                                      ldquoNeuroMalleabilityrdquo

                                                                                                                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                      The reward-and-planning system

                                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                      The reward-and-planning system

                                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                      Lend Me Your Brain

                                                                                                                                      Supporting Clients with Executive Dysfunction

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                      Too busy with current activity

                                                                                                                                      Field dependent

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Sequence problem-solve

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Block out distractions

                                                                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                      - E Goldberg

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Get the reward

                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                      Instant gratification vs

                                                                                                                                      executive gratification

                                                                                                                                      A B C

                                                                                                                                      behaviorx

                                                                                                                                      Self-Talk Proficiency

                                                                                                                                      Self-Talk Proficiency

                                                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                      takerdquordquo

                                                                                                                                      Self-Talk Proficiency

                                                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                                                      Self-Talk Proficiency

                                                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                      thathelliprdquo

                                                                                                                                      Match the Picture

                                                                                                                                      Distraction Delay Training

                                                                                                                                      Executive Estimates Training

                                                                                                                                      X

                                                                                                                                      Learning Time

                                                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                      Learning Time

                                                                                                                                      Learning Time

                                                                                                                                      Learning Time

                                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                      Asking two questionshellip

                                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                                      Am I having fun nowIs

                                                                                                                                      this

                                                                                                                                      what

                                                                                                                                      I se

                                                                                                                                      t out

                                                                                                                                      to

                                                                                                                                      do

                                                                                                                                      bullYesbullYes

                                                                                                                                      bullNobullYes

                                                                                                                                      bullYesbullNo

                                                                                                                                      bullNobullNo

                                                                                                                                      Am I having fun nowIs

                                                                                                                                      this

                                                                                                                                      what

                                                                                                                                      I se

                                                                                                                                      t out

                                                                                                                                      to

                                                                                                                                      do

                                                                                                                                      bullFunbullOn-task

                                                                                                                                      bullNot funbullOn-task

                                                                                                                                      bullFunbullNot on-task

                                                                                                                                      bullNot funbullNot on-task

                                                                                                                                      Key Features of Video Games

                                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                                      Key Features of Video Games

                                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                      Volkow et al 2004

                                                                                                                                      Increase salience

                                                                                                                                      Increase salience

                                                                                                                                      Quarterly QI review

                                                                                                                                      The post-mortem

                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                      Yoga read

                                                                                                                                      Staff meeting

                                                                                                                                      Planningsession

                                                                                                                                      Phone calls

                                                                                                                                      billing

                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                      Learn French

                                                                                                                                      Stop smoking

                                                                                                                                      Be a better spouse

                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                      A CHALLENGEhellip

                                                                                                                                      wwwDrNowellcom

                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                      DavidNowellSeminars

                                                                                                                                      DavidNowell

                                                                                                                                      • Slide 1
                                                                                                                                      • hellipa challenge
                                                                                                                                      • Slide 3
                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                      • Slide 7
                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                      • Overview
                                                                                                                                      • This Dense Pudding
                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                      • Slide 12
                                                                                                                                      • Slide 13
                                                                                                                                      • Developmental considerations
                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                      • Slide 17
                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                      • Slide 19
                                                                                                                                      • Strategies
                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                      • Slide 22
                                                                                                                                      • Slide 23
                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                      • Slide 25
                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                      • Slide 27
                                                                                                                                      • Slide 28
                                                                                                                                      • Slide 29
                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                      • CAPD or ADHD
                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                      • Slide 35
                                                                                                                                      • Strategies (2)
                                                                                                                                      • (C)APD
                                                                                                                                      • Treatment for CAPD
                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                      • Self-assessment
                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                      • Slide 42
                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                      • Core symptoms
                                                                                                                                      • Core symptoms (2)
                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                      • Slide 49
                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                      • Slide 53
                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                      • Subtypes of ADHD
                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                      • Slide 63
                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                      • ADHD and girls
                                                                                                                                      • Slide 66
                                                                                                                                      • Slide 67
                                                                                                                                      • ADHD and women
                                                                                                                                      • Slide 69
                                                                                                                                      • ADHD and women (2)
                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                      • The Executive Functions
                                                                                                                                      • The Executive Functions (2)
                                                                                                                                      • Slide 74
                                                                                                                                      • Slide 75
                                                                                                                                      • Appropriate expectations
                                                                                                                                      • Age-appropriate expectations
                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                      • Slide 84
                                                                                                                                      • Slide 85
                                                                                                                                      • Strategies (3)
                                                                                                                                      • Pharmacotherapy
                                                                                                                                      • Behavioral Supports
                                                                                                                                      • Slide 89
                                                                                                                                      • Slide 90
                                                                                                                                      • Slide 91
                                                                                                                                      • Slide 92
                                                                                                                                      • Slide 93
                                                                                                                                      • Slide 94
                                                                                                                                      • Slide 95
                                                                                                                                      • Slide 96
                                                                                                                                      • Slide 97
                                                                                                                                      • Slide 98
                                                                                                                                      • Slide 99
                                                                                                                                      • Slide 100
                                                                                                                                      • Slide 101
                                                                                                                                      • Slide 102
                                                                                                                                      • Slide 103
                                                                                                                                      • Slide 104
                                                                                                                                      • Slide 105
                                                                                                                                      • Slide 106
                                                                                                                                      • Slide 107
                                                                                                                                      • Slide 108
                                                                                                                                      • Slide 109
                                                                                                                                      • Slide 110
                                                                                                                                      • Time Out
                                                                                                                                      • Token economy
                                                                                                                                      • Slide 113
                                                                                                                                      • Slide 114
                                                                                                                                      • Slide 115
                                                                                                                                      • Intrinsic motivation
                                                                                                                                      • Slide 117
                                                                                                                                      • Slide 118
                                                                                                                                      • Slide 119
                                                                                                                                      • Metacognition
                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                      • Slide 124
                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                      • Slide 128
                                                                                                                                      • Slide 129
                                                                                                                                      • Broaden and Build
                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                      • The reward-and-planning system
                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                      • Slide 141
                                                                                                                                      • Lend Me Your Brain
                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                      • Slide 146
                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                      • Slide 149
                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                      • Slide 152
                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                      • Slide 154
                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                      • Slide 157
                                                                                                                                      • Slide 158
                                                                                                                                      • Slide 159
                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                      • Slide 162
                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                      • Slide 164
                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                      • Slide 166
                                                                                                                                      • Slide 167
                                                                                                                                      • Slide 168
                                                                                                                                      • Slide 169
                                                                                                                                      • Slide 170
                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                      • Match the Picture
                                                                                                                                      • Slide 176
                                                                                                                                      • Slide 177
                                                                                                                                      • Distraction Delay Training
                                                                                                                                      • Slide 179
                                                                                                                                      • Slide 180
                                                                                                                                      • Executive Estimates Training
                                                                                                                                      • Learning Time
                                                                                                                                      • Learning Time (2)
                                                                                                                                      • Learning Time (3)
                                                                                                                                      • Slide 185
                                                                                                                                      • Slide 186
                                                                                                                                      • Learning Time (4)
                                                                                                                                      • Asking two questionshellip
                                                                                                                                      • Slide 189
                                                                                                                                      • Slide 190
                                                                                                                                      • Key Features of Video Games
                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                      • Slide 194
                                                                                                                                      • Slide 195
                                                                                                                                      • Slide 196
                                                                                                                                      • Slide 197
                                                                                                                                      • Slide 198
                                                                                                                                      • Slide 199
                                                                                                                                      • Slide 200
                                                                                                                                      • Slide 201
                                                                                                                                      • Quarterly QI review
                                                                                                                                      • The post-mortem
                                                                                                                                      • Slide 204
                                                                                                                                      • Slide 205
                                                                                                                                      • Slide 206
                                                                                                                                      • Slide 207
                                                                                                                                      • Slide 208
                                                                                                                                      • Slide 209
                                                                                                                                      • Slide 210
                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                      • Slide 212
                                                                                                                                      • Slide 213
                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                      • Slide 215
                                                                                                                                      • Slide 216
                                                                                                                                      • Slide 217
                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                      • A challengehellip
                                                                                                                                      • Slide 222

                                                                                                                                        Behavioral Supports

                                                                                                                                        A B C

                                                                                                                                        A B C

                                                                                                                                        behavior

                                                                                                                                        A B C

                                                                                                                                        consequences

                                                                                                                                        A B C

                                                                                                                                        antecedent

                                                                                                                                        A B C

                                                                                                                                        A B C

                                                                                                                                        antecedent

                                                                                                                                        A B C

                                                                                                                                        antecedent

                                                                                                                                        easy hard

                                                                                                                                        A B C

                                                                                                                                        consequences

                                                                                                                                        R P

                                                                                                                                        +

                                                                                                                                        -

                                                                                                                                        R+ P+

                                                                                                                                        R- P-

                                                                                                                                        Time Out

                                                                                                                                        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                        Token economy

                                                                                                                                        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                        Intrinsic motivation

                                                                                                                                        A B C

                                                                                                                                        consequencesX

                                                                                                                                        A B C

                                                                                                                                        behavior

                                                                                                                                        Metacognition

                                                                                                                                        Metacognitive knowledge Metacognitive strategies

                                                                                                                                        ldquoLend Me Your Brainrdquo

                                                                                                                                        What Does Dopamine Feel Like

                                                                                                                                        The Physiology of Motivation and Reward

                                                                                                                                        Preferred States What Does Dopamine Feel Like

                                                                                                                                        1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                        David D Nowell PhD189 May Street

                                                                                                                                        Worcester Mass 01602DrNowellcom

                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                        wwwLulucom

                                                                                                                                        Identify 20 peak experiences For each peak experience identify the

                                                                                                                                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                        of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                        clusters groupings There will probably be 4 or 5

                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                        Find a word a label for each of the groupings

                                                                                                                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                        ldquovaluesrdquo ways that you really like to feel

                                                                                                                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                        Broaden and Build

                                                                                                                                        ldquoNeuroMalleabilityrdquo

                                                                                                                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                        The reward-and-planning system

                                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                        The reward-and-planning system

                                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                        Lend Me Your Brain

                                                                                                                                        Supporting Clients with Executive Dysfunction

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                        Too busy with current activity

                                                                                                                                        Field dependent

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Sequence problem-solve

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Block out distractions

                                                                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                        - E Goldberg

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Get the reward

                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                        Instant gratification vs

                                                                                                                                        executive gratification

                                                                                                                                        A B C

                                                                                                                                        behaviorx

                                                                                                                                        Self-Talk Proficiency

                                                                                                                                        Self-Talk Proficiency

                                                                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                        takerdquordquo

                                                                                                                                        Self-Talk Proficiency

                                                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                                                        Self-Talk Proficiency

                                                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                        thathelliprdquo

                                                                                                                                        Match the Picture

                                                                                                                                        Distraction Delay Training

                                                                                                                                        Executive Estimates Training

                                                                                                                                        X

                                                                                                                                        Learning Time

                                                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                        Learning Time

                                                                                                                                        Learning Time

                                                                                                                                        Learning Time

                                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                        Asking two questionshellip

                                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                                        Am I having fun nowIs

                                                                                                                                        this

                                                                                                                                        what

                                                                                                                                        I se

                                                                                                                                        t out

                                                                                                                                        to

                                                                                                                                        do

                                                                                                                                        bullYesbullYes

                                                                                                                                        bullNobullYes

                                                                                                                                        bullYesbullNo

                                                                                                                                        bullNobullNo

                                                                                                                                        Am I having fun nowIs

                                                                                                                                        this

                                                                                                                                        what

                                                                                                                                        I se

                                                                                                                                        t out

                                                                                                                                        to

                                                                                                                                        do

                                                                                                                                        bullFunbullOn-task

                                                                                                                                        bullNot funbullOn-task

                                                                                                                                        bullFunbullNot on-task

                                                                                                                                        bullNot funbullNot on-task

                                                                                                                                        Key Features of Video Games

                                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                                        Key Features of Video Games

                                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                        Volkow et al 2004

                                                                                                                                        Increase salience

                                                                                                                                        Increase salience

                                                                                                                                        Quarterly QI review

                                                                                                                                        The post-mortem

                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                        Yoga read

                                                                                                                                        Staff meeting

                                                                                                                                        Planningsession

                                                                                                                                        Phone calls

                                                                                                                                        billing

                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                        Learn French

                                                                                                                                        Stop smoking

                                                                                                                                        Be a better spouse

                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                        A CHALLENGEhellip

                                                                                                                                        wwwDrNowellcom

                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                        DavidNowellSeminars

                                                                                                                                        DavidNowell

                                                                                                                                        • Slide 1
                                                                                                                                        • hellipa challenge
                                                                                                                                        • Slide 3
                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                        • Slide 7
                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                        • Overview
                                                                                                                                        • This Dense Pudding
                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                        • Slide 12
                                                                                                                                        • Slide 13
                                                                                                                                        • Developmental considerations
                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                        • Slide 17
                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                        • Slide 19
                                                                                                                                        • Strategies
                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                        • Slide 22
                                                                                                                                        • Slide 23
                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                        • Slide 25
                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                        • Slide 27
                                                                                                                                        • Slide 28
                                                                                                                                        • Slide 29
                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                        • CAPD or ADHD
                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                        • Slide 35
                                                                                                                                        • Strategies (2)
                                                                                                                                        • (C)APD
                                                                                                                                        • Treatment for CAPD
                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                        • Self-assessment
                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                        • Slide 42
                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                        • Core symptoms
                                                                                                                                        • Core symptoms (2)
                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                        • Slide 49
                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                        • Slide 53
                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                        • Subtypes of ADHD
                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                        • Slide 63
                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                        • ADHD and girls
                                                                                                                                        • Slide 66
                                                                                                                                        • Slide 67
                                                                                                                                        • ADHD and women
                                                                                                                                        • Slide 69
                                                                                                                                        • ADHD and women (2)
                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                        • The Executive Functions
                                                                                                                                        • The Executive Functions (2)
                                                                                                                                        • Slide 74
                                                                                                                                        • Slide 75
                                                                                                                                        • Appropriate expectations
                                                                                                                                        • Age-appropriate expectations
                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                        • Slide 84
                                                                                                                                        • Slide 85
                                                                                                                                        • Strategies (3)
                                                                                                                                        • Pharmacotherapy
                                                                                                                                        • Behavioral Supports
                                                                                                                                        • Slide 89
                                                                                                                                        • Slide 90
                                                                                                                                        • Slide 91
                                                                                                                                        • Slide 92
                                                                                                                                        • Slide 93
                                                                                                                                        • Slide 94
                                                                                                                                        • Slide 95
                                                                                                                                        • Slide 96
                                                                                                                                        • Slide 97
                                                                                                                                        • Slide 98
                                                                                                                                        • Slide 99
                                                                                                                                        • Slide 100
                                                                                                                                        • Slide 101
                                                                                                                                        • Slide 102
                                                                                                                                        • Slide 103
                                                                                                                                        • Slide 104
                                                                                                                                        • Slide 105
                                                                                                                                        • Slide 106
                                                                                                                                        • Slide 107
                                                                                                                                        • Slide 108
                                                                                                                                        • Slide 109
                                                                                                                                        • Slide 110
                                                                                                                                        • Time Out
                                                                                                                                        • Token economy
                                                                                                                                        • Slide 113
                                                                                                                                        • Slide 114
                                                                                                                                        • Slide 115
                                                                                                                                        • Intrinsic motivation
                                                                                                                                        • Slide 117
                                                                                                                                        • Slide 118
                                                                                                                                        • Slide 119
                                                                                                                                        • Metacognition
                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                        • Slide 124
                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                        • Slide 128
                                                                                                                                        • Slide 129
                                                                                                                                        • Broaden and Build
                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                        • The reward-and-planning system
                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                        • Slide 141
                                                                                                                                        • Lend Me Your Brain
                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                        • Slide 146
                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                        • Slide 149
                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                        • Slide 152
                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                        • Slide 154
                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                        • Slide 157
                                                                                                                                        • Slide 158
                                                                                                                                        • Slide 159
                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                        • Slide 162
                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                        • Slide 164
                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                        • Slide 166
                                                                                                                                        • Slide 167
                                                                                                                                        • Slide 168
                                                                                                                                        • Slide 169
                                                                                                                                        • Slide 170
                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                        • Match the Picture
                                                                                                                                        • Slide 176
                                                                                                                                        • Slide 177
                                                                                                                                        • Distraction Delay Training
                                                                                                                                        • Slide 179
                                                                                                                                        • Slide 180
                                                                                                                                        • Executive Estimates Training
                                                                                                                                        • Learning Time
                                                                                                                                        • Learning Time (2)
                                                                                                                                        • Learning Time (3)
                                                                                                                                        • Slide 185
                                                                                                                                        • Slide 186
                                                                                                                                        • Learning Time (4)
                                                                                                                                        • Asking two questionshellip
                                                                                                                                        • Slide 189
                                                                                                                                        • Slide 190
                                                                                                                                        • Key Features of Video Games
                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                        • Slide 194
                                                                                                                                        • Slide 195
                                                                                                                                        • Slide 196
                                                                                                                                        • Slide 197
                                                                                                                                        • Slide 198
                                                                                                                                        • Slide 199
                                                                                                                                        • Slide 200
                                                                                                                                        • Slide 201
                                                                                                                                        • Quarterly QI review
                                                                                                                                        • The post-mortem
                                                                                                                                        • Slide 204
                                                                                                                                        • Slide 205
                                                                                                                                        • Slide 206
                                                                                                                                        • Slide 207
                                                                                                                                        • Slide 208
                                                                                                                                        • Slide 209
                                                                                                                                        • Slide 210
                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                        • Slide 212
                                                                                                                                        • Slide 213
                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                        • Slide 215
                                                                                                                                        • Slide 216
                                                                                                                                        • Slide 217
                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                        • A challengehellip
                                                                                                                                        • Slide 222

                                                                                                                                          A B C

                                                                                                                                          A B C

                                                                                                                                          behavior

                                                                                                                                          A B C

                                                                                                                                          consequences

                                                                                                                                          A B C

                                                                                                                                          antecedent

                                                                                                                                          A B C

                                                                                                                                          A B C

                                                                                                                                          antecedent

                                                                                                                                          A B C

                                                                                                                                          antecedent

                                                                                                                                          easy hard

                                                                                                                                          A B C

                                                                                                                                          consequences

                                                                                                                                          R P

                                                                                                                                          +

                                                                                                                                          -

                                                                                                                                          R+ P+

                                                                                                                                          R- P-

                                                                                                                                          Time Out

                                                                                                                                          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                          Token economy

                                                                                                                                          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                          Intrinsic motivation

                                                                                                                                          A B C

                                                                                                                                          consequencesX

                                                                                                                                          A B C

                                                                                                                                          behavior

                                                                                                                                          Metacognition

                                                                                                                                          Metacognitive knowledge Metacognitive strategies

                                                                                                                                          ldquoLend Me Your Brainrdquo

                                                                                                                                          What Does Dopamine Feel Like

                                                                                                                                          The Physiology of Motivation and Reward

                                                                                                                                          Preferred States What Does Dopamine Feel Like

                                                                                                                                          1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                          David D Nowell PhD189 May Street

                                                                                                                                          Worcester Mass 01602DrNowellcom

                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                          wwwLulucom

                                                                                                                                          Identify 20 peak experiences For each peak experience identify the

                                                                                                                                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                          of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                          clusters groupings There will probably be 4 or 5

                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                          Find a word a label for each of the groupings

                                                                                                                                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                          ldquovaluesrdquo ways that you really like to feel

                                                                                                                                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                          Broaden and Build

                                                                                                                                          ldquoNeuroMalleabilityrdquo

                                                                                                                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                          The reward-and-planning system

                                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                          The reward-and-planning system

                                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                          Lend Me Your Brain

                                                                                                                                          Supporting Clients with Executive Dysfunction

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                          Too busy with current activity

                                                                                                                                          Field dependent

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Sequence problem-solve

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Block out distractions

                                                                                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                          - E Goldberg

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Get the reward

                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                          Instant gratification vs

                                                                                                                                          executive gratification

                                                                                                                                          A B C

                                                                                                                                          behaviorx

                                                                                                                                          Self-Talk Proficiency

                                                                                                                                          Self-Talk Proficiency

                                                                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                          takerdquordquo

                                                                                                                                          Self-Talk Proficiency

                                                                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                                                                          Self-Talk Proficiency

                                                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                          thathelliprdquo

                                                                                                                                          Match the Picture

                                                                                                                                          Distraction Delay Training

                                                                                                                                          Executive Estimates Training

                                                                                                                                          X

                                                                                                                                          Learning Time

                                                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                          Learning Time

                                                                                                                                          Learning Time

                                                                                                                                          Learning Time

                                                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                          Asking two questionshellip

                                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                                          Am I having fun nowIs

                                                                                                                                          this

                                                                                                                                          what

                                                                                                                                          I se

                                                                                                                                          t out

                                                                                                                                          to

                                                                                                                                          do

                                                                                                                                          bullYesbullYes

                                                                                                                                          bullNobullYes

                                                                                                                                          bullYesbullNo

                                                                                                                                          bullNobullNo

                                                                                                                                          Am I having fun nowIs

                                                                                                                                          this

                                                                                                                                          what

                                                                                                                                          I se

                                                                                                                                          t out

                                                                                                                                          to

                                                                                                                                          do

                                                                                                                                          bullFunbullOn-task

                                                                                                                                          bullNot funbullOn-task

                                                                                                                                          bullFunbullNot on-task

                                                                                                                                          bullNot funbullNot on-task

                                                                                                                                          Key Features of Video Games

                                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                                          Key Features of Video Games

                                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                          Volkow et al 2004

                                                                                                                                          Increase salience

                                                                                                                                          Increase salience

                                                                                                                                          Quarterly QI review

                                                                                                                                          The post-mortem

                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                          Yoga read

                                                                                                                                          Staff meeting

                                                                                                                                          Planningsession

                                                                                                                                          Phone calls

                                                                                                                                          billing

                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                          Learn French

                                                                                                                                          Stop smoking

                                                                                                                                          Be a better spouse

                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                          A CHALLENGEhellip

                                                                                                                                          wwwDrNowellcom

                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                          DavidNowellSeminars

                                                                                                                                          DavidNowell

                                                                                                                                          • Slide 1
                                                                                                                                          • hellipa challenge
                                                                                                                                          • Slide 3
                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                          • Slide 7
                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                          • Overview
                                                                                                                                          • This Dense Pudding
                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                          • Slide 12
                                                                                                                                          • Slide 13
                                                                                                                                          • Developmental considerations
                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                          • Slide 17
                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                          • Slide 19
                                                                                                                                          • Strategies
                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                          • Slide 22
                                                                                                                                          • Slide 23
                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                          • Slide 25
                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                          • Slide 27
                                                                                                                                          • Slide 28
                                                                                                                                          • Slide 29
                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                          • CAPD or ADHD
                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                          • Slide 35
                                                                                                                                          • Strategies (2)
                                                                                                                                          • (C)APD
                                                                                                                                          • Treatment for CAPD
                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                          • Self-assessment
                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                          • Slide 42
                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                          • Core symptoms
                                                                                                                                          • Core symptoms (2)
                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                          • Slide 49
                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                          • Slide 53
                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                          • Subtypes of ADHD
                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                          • Slide 63
                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                          • ADHD and girls
                                                                                                                                          • Slide 66
                                                                                                                                          • Slide 67
                                                                                                                                          • ADHD and women
                                                                                                                                          • Slide 69
                                                                                                                                          • ADHD and women (2)
                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                          • The Executive Functions
                                                                                                                                          • The Executive Functions (2)
                                                                                                                                          • Slide 74
                                                                                                                                          • Slide 75
                                                                                                                                          • Appropriate expectations
                                                                                                                                          • Age-appropriate expectations
                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                          • Slide 84
                                                                                                                                          • Slide 85
                                                                                                                                          • Strategies (3)
                                                                                                                                          • Pharmacotherapy
                                                                                                                                          • Behavioral Supports
                                                                                                                                          • Slide 89
                                                                                                                                          • Slide 90
                                                                                                                                          • Slide 91
                                                                                                                                          • Slide 92
                                                                                                                                          • Slide 93
                                                                                                                                          • Slide 94
                                                                                                                                          • Slide 95
                                                                                                                                          • Slide 96
                                                                                                                                          • Slide 97
                                                                                                                                          • Slide 98
                                                                                                                                          • Slide 99
                                                                                                                                          • Slide 100
                                                                                                                                          • Slide 101
                                                                                                                                          • Slide 102
                                                                                                                                          • Slide 103
                                                                                                                                          • Slide 104
                                                                                                                                          • Slide 105
                                                                                                                                          • Slide 106
                                                                                                                                          • Slide 107
                                                                                                                                          • Slide 108
                                                                                                                                          • Slide 109
                                                                                                                                          • Slide 110
                                                                                                                                          • Time Out
                                                                                                                                          • Token economy
                                                                                                                                          • Slide 113
                                                                                                                                          • Slide 114
                                                                                                                                          • Slide 115
                                                                                                                                          • Intrinsic motivation
                                                                                                                                          • Slide 117
                                                                                                                                          • Slide 118
                                                                                                                                          • Slide 119
                                                                                                                                          • Metacognition
                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                          • Slide 124
                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                          • Slide 128
                                                                                                                                          • Slide 129
                                                                                                                                          • Broaden and Build
                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                          • The reward-and-planning system
                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                          • Slide 141
                                                                                                                                          • Lend Me Your Brain
                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                          • Slide 146
                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                          • Slide 149
                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                          • Slide 152
                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                          • Slide 154
                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                          • Slide 157
                                                                                                                                          • Slide 158
                                                                                                                                          • Slide 159
                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                          • Slide 162
                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                          • Slide 164
                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                          • Slide 166
                                                                                                                                          • Slide 167
                                                                                                                                          • Slide 168
                                                                                                                                          • Slide 169
                                                                                                                                          • Slide 170
                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                          • Match the Picture
                                                                                                                                          • Slide 176
                                                                                                                                          • Slide 177
                                                                                                                                          • Distraction Delay Training
                                                                                                                                          • Slide 179
                                                                                                                                          • Slide 180
                                                                                                                                          • Executive Estimates Training
                                                                                                                                          • Learning Time
                                                                                                                                          • Learning Time (2)
                                                                                                                                          • Learning Time (3)
                                                                                                                                          • Slide 185
                                                                                                                                          • Slide 186
                                                                                                                                          • Learning Time (4)
                                                                                                                                          • Asking two questionshellip
                                                                                                                                          • Slide 189
                                                                                                                                          • Slide 190
                                                                                                                                          • Key Features of Video Games
                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                          • Slide 194
                                                                                                                                          • Slide 195
                                                                                                                                          • Slide 196
                                                                                                                                          • Slide 197
                                                                                                                                          • Slide 198
                                                                                                                                          • Slide 199
                                                                                                                                          • Slide 200
                                                                                                                                          • Slide 201
                                                                                                                                          • Quarterly QI review
                                                                                                                                          • The post-mortem
                                                                                                                                          • Slide 204
                                                                                                                                          • Slide 205
                                                                                                                                          • Slide 206
                                                                                                                                          • Slide 207
                                                                                                                                          • Slide 208
                                                                                                                                          • Slide 209
                                                                                                                                          • Slide 210
                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                          • Slide 212
                                                                                                                                          • Slide 213
                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                          • Slide 215
                                                                                                                                          • Slide 216
                                                                                                                                          • Slide 217
                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                          • A challengehellip
                                                                                                                                          • Slide 222

                                                                                                                                            A B C

                                                                                                                                            behavior

                                                                                                                                            A B C

                                                                                                                                            consequences

                                                                                                                                            A B C

                                                                                                                                            antecedent

                                                                                                                                            A B C

                                                                                                                                            A B C

                                                                                                                                            antecedent

                                                                                                                                            A B C

                                                                                                                                            antecedent

                                                                                                                                            easy hard

                                                                                                                                            A B C

                                                                                                                                            consequences

                                                                                                                                            R P

                                                                                                                                            +

                                                                                                                                            -

                                                                                                                                            R+ P+

                                                                                                                                            R- P-

                                                                                                                                            Time Out

                                                                                                                                            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                            Token economy

                                                                                                                                            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                            Intrinsic motivation

                                                                                                                                            A B C

                                                                                                                                            consequencesX

                                                                                                                                            A B C

                                                                                                                                            behavior

                                                                                                                                            Metacognition

                                                                                                                                            Metacognitive knowledge Metacognitive strategies

                                                                                                                                            ldquoLend Me Your Brainrdquo

                                                                                                                                            What Does Dopamine Feel Like

                                                                                                                                            The Physiology of Motivation and Reward

                                                                                                                                            Preferred States What Does Dopamine Feel Like

                                                                                                                                            1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                            David D Nowell PhD189 May Street

                                                                                                                                            Worcester Mass 01602DrNowellcom

                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                            wwwLulucom

                                                                                                                                            Identify 20 peak experiences For each peak experience identify the

                                                                                                                                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                            of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                            clusters groupings There will probably be 4 or 5

                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                            Find a word a label for each of the groupings

                                                                                                                                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                            ldquovaluesrdquo ways that you really like to feel

                                                                                                                                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                            Broaden and Build

                                                                                                                                            ldquoNeuroMalleabilityrdquo

                                                                                                                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                            The reward-and-planning system

                                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                            The reward-and-planning system

                                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                            Lend Me Your Brain

                                                                                                                                            Supporting Clients with Executive Dysfunction

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                            Too busy with current activity

                                                                                                                                            Field dependent

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Sequence problem-solve

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Block out distractions

                                                                                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                            - E Goldberg

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Get the reward

                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                            Instant gratification vs

                                                                                                                                            executive gratification

                                                                                                                                            A B C

                                                                                                                                            behaviorx

                                                                                                                                            Self-Talk Proficiency

                                                                                                                                            Self-Talk Proficiency

                                                                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                            takerdquordquo

                                                                                                                                            Self-Talk Proficiency

                                                                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                                                                            Self-Talk Proficiency

                                                                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                            thathelliprdquo

                                                                                                                                            Match the Picture

                                                                                                                                            Distraction Delay Training

                                                                                                                                            Executive Estimates Training

                                                                                                                                            X

                                                                                                                                            Learning Time

                                                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                            Learning Time

                                                                                                                                            Learning Time

                                                                                                                                            Learning Time

                                                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                            Asking two questionshellip

                                                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                                                            Am I having fun nowIs

                                                                                                                                            this

                                                                                                                                            what

                                                                                                                                            I se

                                                                                                                                            t out

                                                                                                                                            to

                                                                                                                                            do

                                                                                                                                            bullYesbullYes

                                                                                                                                            bullNobullYes

                                                                                                                                            bullYesbullNo

                                                                                                                                            bullNobullNo

                                                                                                                                            Am I having fun nowIs

                                                                                                                                            this

                                                                                                                                            what

                                                                                                                                            I se

                                                                                                                                            t out

                                                                                                                                            to

                                                                                                                                            do

                                                                                                                                            bullFunbullOn-task

                                                                                                                                            bullNot funbullOn-task

                                                                                                                                            bullFunbullNot on-task

                                                                                                                                            bullNot funbullNot on-task

                                                                                                                                            Key Features of Video Games

                                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                                            Key Features of Video Games

                                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                            Volkow et al 2004

                                                                                                                                            Increase salience

                                                                                                                                            Increase salience

                                                                                                                                            Quarterly QI review

                                                                                                                                            The post-mortem

                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                            Yoga read

                                                                                                                                            Staff meeting

                                                                                                                                            Planningsession

                                                                                                                                            Phone calls

                                                                                                                                            billing

                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                            Learn French

                                                                                                                                            Stop smoking

                                                                                                                                            Be a better spouse

                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                            A CHALLENGEhellip

                                                                                                                                            wwwDrNowellcom

                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                            DavidNowellSeminars

                                                                                                                                            DavidNowell

                                                                                                                                            • Slide 1
                                                                                                                                            • hellipa challenge
                                                                                                                                            • Slide 3
                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                            • Slide 7
                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                            • Overview
                                                                                                                                            • This Dense Pudding
                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                            • Slide 12
                                                                                                                                            • Slide 13
                                                                                                                                            • Developmental considerations
                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                            • Slide 17
                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                            • Slide 19
                                                                                                                                            • Strategies
                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                            • Slide 22
                                                                                                                                            • Slide 23
                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                            • Slide 25
                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                            • Slide 27
                                                                                                                                            • Slide 28
                                                                                                                                            • Slide 29
                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                            • CAPD or ADHD
                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                            • Slide 35
                                                                                                                                            • Strategies (2)
                                                                                                                                            • (C)APD
                                                                                                                                            • Treatment for CAPD
                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                            • Self-assessment
                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                            • Slide 42
                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                            • Core symptoms
                                                                                                                                            • Core symptoms (2)
                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                            • Slide 49
                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                            • Slide 53
                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                            • Subtypes of ADHD
                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                            • Slide 63
                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                            • ADHD and girls
                                                                                                                                            • Slide 66
                                                                                                                                            • Slide 67
                                                                                                                                            • ADHD and women
                                                                                                                                            • Slide 69
                                                                                                                                            • ADHD and women (2)
                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                            • The Executive Functions
                                                                                                                                            • The Executive Functions (2)
                                                                                                                                            • Slide 74
                                                                                                                                            • Slide 75
                                                                                                                                            • Appropriate expectations
                                                                                                                                            • Age-appropriate expectations
                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                            • Slide 84
                                                                                                                                            • Slide 85
                                                                                                                                            • Strategies (3)
                                                                                                                                            • Pharmacotherapy
                                                                                                                                            • Behavioral Supports
                                                                                                                                            • Slide 89
                                                                                                                                            • Slide 90
                                                                                                                                            • Slide 91
                                                                                                                                            • Slide 92
                                                                                                                                            • Slide 93
                                                                                                                                            • Slide 94
                                                                                                                                            • Slide 95
                                                                                                                                            • Slide 96
                                                                                                                                            • Slide 97
                                                                                                                                            • Slide 98
                                                                                                                                            • Slide 99
                                                                                                                                            • Slide 100
                                                                                                                                            • Slide 101
                                                                                                                                            • Slide 102
                                                                                                                                            • Slide 103
                                                                                                                                            • Slide 104
                                                                                                                                            • Slide 105
                                                                                                                                            • Slide 106
                                                                                                                                            • Slide 107
                                                                                                                                            • Slide 108
                                                                                                                                            • Slide 109
                                                                                                                                            • Slide 110
                                                                                                                                            • Time Out
                                                                                                                                            • Token economy
                                                                                                                                            • Slide 113
                                                                                                                                            • Slide 114
                                                                                                                                            • Slide 115
                                                                                                                                            • Intrinsic motivation
                                                                                                                                            • Slide 117
                                                                                                                                            • Slide 118
                                                                                                                                            • Slide 119
                                                                                                                                            • Metacognition
                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                            • Slide 124
                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                            • Slide 128
                                                                                                                                            • Slide 129
                                                                                                                                            • Broaden and Build
                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                            • The reward-and-planning system
                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                            • Slide 141
                                                                                                                                            • Lend Me Your Brain
                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                            • Slide 146
                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                            • Slide 149
                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                            • Slide 152
                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                            • Slide 154
                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                            • Slide 157
                                                                                                                                            • Slide 158
                                                                                                                                            • Slide 159
                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                            • Slide 162
                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                            • Slide 164
                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                            • Slide 166
                                                                                                                                            • Slide 167
                                                                                                                                            • Slide 168
                                                                                                                                            • Slide 169
                                                                                                                                            • Slide 170
                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                            • Match the Picture
                                                                                                                                            • Slide 176
                                                                                                                                            • Slide 177
                                                                                                                                            • Distraction Delay Training
                                                                                                                                            • Slide 179
                                                                                                                                            • Slide 180
                                                                                                                                            • Executive Estimates Training
                                                                                                                                            • Learning Time
                                                                                                                                            • Learning Time (2)
                                                                                                                                            • Learning Time (3)
                                                                                                                                            • Slide 185
                                                                                                                                            • Slide 186
                                                                                                                                            • Learning Time (4)
                                                                                                                                            • Asking two questionshellip
                                                                                                                                            • Slide 189
                                                                                                                                            • Slide 190
                                                                                                                                            • Key Features of Video Games
                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                            • Slide 194
                                                                                                                                            • Slide 195
                                                                                                                                            • Slide 196
                                                                                                                                            • Slide 197
                                                                                                                                            • Slide 198
                                                                                                                                            • Slide 199
                                                                                                                                            • Slide 200
                                                                                                                                            • Slide 201
                                                                                                                                            • Quarterly QI review
                                                                                                                                            • The post-mortem
                                                                                                                                            • Slide 204
                                                                                                                                            • Slide 205
                                                                                                                                            • Slide 206
                                                                                                                                            • Slide 207
                                                                                                                                            • Slide 208
                                                                                                                                            • Slide 209
                                                                                                                                            • Slide 210
                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                            • Slide 212
                                                                                                                                            • Slide 213
                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                            • Slide 215
                                                                                                                                            • Slide 216
                                                                                                                                            • Slide 217
                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                            • A challengehellip
                                                                                                                                            • Slide 222

                                                                                                                                              A B C

                                                                                                                                              consequences

                                                                                                                                              A B C

                                                                                                                                              antecedent

                                                                                                                                              A B C

                                                                                                                                              A B C

                                                                                                                                              antecedent

                                                                                                                                              A B C

                                                                                                                                              antecedent

                                                                                                                                              easy hard

                                                                                                                                              A B C

                                                                                                                                              consequences

                                                                                                                                              R P

                                                                                                                                              +

                                                                                                                                              -

                                                                                                                                              R+ P+

                                                                                                                                              R- P-

                                                                                                                                              Time Out

                                                                                                                                              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                              Token economy

                                                                                                                                              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                              Intrinsic motivation

                                                                                                                                              A B C

                                                                                                                                              consequencesX

                                                                                                                                              A B C

                                                                                                                                              behavior

                                                                                                                                              Metacognition

                                                                                                                                              Metacognitive knowledge Metacognitive strategies

                                                                                                                                              ldquoLend Me Your Brainrdquo

                                                                                                                                              What Does Dopamine Feel Like

                                                                                                                                              The Physiology of Motivation and Reward

                                                                                                                                              Preferred States What Does Dopamine Feel Like

                                                                                                                                              1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                              David D Nowell PhD189 May Street

                                                                                                                                              Worcester Mass 01602DrNowellcom

                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                              wwwLulucom

                                                                                                                                              Identify 20 peak experiences For each peak experience identify the

                                                                                                                                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                              of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                              clusters groupings There will probably be 4 or 5

                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                              Find a word a label for each of the groupings

                                                                                                                                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                              ldquovaluesrdquo ways that you really like to feel

                                                                                                                                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                              Broaden and Build

                                                                                                                                              ldquoNeuroMalleabilityrdquo

                                                                                                                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                              The reward-and-planning system

                                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                              The reward-and-planning system

                                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                              Lend Me Your Brain

                                                                                                                                              Supporting Clients with Executive Dysfunction

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                              Too busy with current activity

                                                                                                                                              Field dependent

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Sequence problem-solve

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Block out distractions

                                                                                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                              - E Goldberg

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Get the reward

                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                              Instant gratification vs

                                                                                                                                              executive gratification

                                                                                                                                              A B C

                                                                                                                                              behaviorx

                                                                                                                                              Self-Talk Proficiency

                                                                                                                                              Self-Talk Proficiency

                                                                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                              takerdquordquo

                                                                                                                                              Self-Talk Proficiency

                                                                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                                                                              Self-Talk Proficiency

                                                                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                              thathelliprdquo

                                                                                                                                              Match the Picture

                                                                                                                                              Distraction Delay Training

                                                                                                                                              Executive Estimates Training

                                                                                                                                              X

                                                                                                                                              Learning Time

                                                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                              Learning Time

                                                                                                                                              Learning Time

                                                                                                                                              Learning Time

                                                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                              Asking two questionshellip

                                                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                                                              Am I having fun nowIs

                                                                                                                                              this

                                                                                                                                              what

                                                                                                                                              I se

                                                                                                                                              t out

                                                                                                                                              to

                                                                                                                                              do

                                                                                                                                              bullYesbullYes

                                                                                                                                              bullNobullYes

                                                                                                                                              bullYesbullNo

                                                                                                                                              bullNobullNo

                                                                                                                                              Am I having fun nowIs

                                                                                                                                              this

                                                                                                                                              what

                                                                                                                                              I se

                                                                                                                                              t out

                                                                                                                                              to

                                                                                                                                              do

                                                                                                                                              bullFunbullOn-task

                                                                                                                                              bullNot funbullOn-task

                                                                                                                                              bullFunbullNot on-task

                                                                                                                                              bullNot funbullNot on-task

                                                                                                                                              Key Features of Video Games

                                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                                              Key Features of Video Games

                                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                              Volkow et al 2004

                                                                                                                                              Increase salience

                                                                                                                                              Increase salience

                                                                                                                                              Quarterly QI review

                                                                                                                                              The post-mortem

                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                              Yoga read

                                                                                                                                              Staff meeting

                                                                                                                                              Planningsession

                                                                                                                                              Phone calls

                                                                                                                                              billing

                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                              Learn French

                                                                                                                                              Stop smoking

                                                                                                                                              Be a better spouse

                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                              A CHALLENGEhellip

                                                                                                                                              wwwDrNowellcom

                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                              DavidNowellSeminars

                                                                                                                                              DavidNowell

                                                                                                                                              • Slide 1
                                                                                                                                              • hellipa challenge
                                                                                                                                              • Slide 3
                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                              • Slide 7
                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                              • Overview
                                                                                                                                              • This Dense Pudding
                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                              • Slide 12
                                                                                                                                              • Slide 13
                                                                                                                                              • Developmental considerations
                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                              • Slide 17
                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                              • Slide 19
                                                                                                                                              • Strategies
                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                              • Slide 22
                                                                                                                                              • Slide 23
                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                              • Slide 25
                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                              • Slide 27
                                                                                                                                              • Slide 28
                                                                                                                                              • Slide 29
                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                              • CAPD or ADHD
                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                              • Slide 35
                                                                                                                                              • Strategies (2)
                                                                                                                                              • (C)APD
                                                                                                                                              • Treatment for CAPD
                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                              • Self-assessment
                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                              • Slide 42
                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                              • Core symptoms
                                                                                                                                              • Core symptoms (2)
                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                              • Slide 49
                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                              • Slide 53
                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                              • Subtypes of ADHD
                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                              • Slide 63
                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                              • ADHD and girls
                                                                                                                                              • Slide 66
                                                                                                                                              • Slide 67
                                                                                                                                              • ADHD and women
                                                                                                                                              • Slide 69
                                                                                                                                              • ADHD and women (2)
                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                              • The Executive Functions
                                                                                                                                              • The Executive Functions (2)
                                                                                                                                              • Slide 74
                                                                                                                                              • Slide 75
                                                                                                                                              • Appropriate expectations
                                                                                                                                              • Age-appropriate expectations
                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                              • Slide 84
                                                                                                                                              • Slide 85
                                                                                                                                              • Strategies (3)
                                                                                                                                              • Pharmacotherapy
                                                                                                                                              • Behavioral Supports
                                                                                                                                              • Slide 89
                                                                                                                                              • Slide 90
                                                                                                                                              • Slide 91
                                                                                                                                              • Slide 92
                                                                                                                                              • Slide 93
                                                                                                                                              • Slide 94
                                                                                                                                              • Slide 95
                                                                                                                                              • Slide 96
                                                                                                                                              • Slide 97
                                                                                                                                              • Slide 98
                                                                                                                                              • Slide 99
                                                                                                                                              • Slide 100
                                                                                                                                              • Slide 101
                                                                                                                                              • Slide 102
                                                                                                                                              • Slide 103
                                                                                                                                              • Slide 104
                                                                                                                                              • Slide 105
                                                                                                                                              • Slide 106
                                                                                                                                              • Slide 107
                                                                                                                                              • Slide 108
                                                                                                                                              • Slide 109
                                                                                                                                              • Slide 110
                                                                                                                                              • Time Out
                                                                                                                                              • Token economy
                                                                                                                                              • Slide 113
                                                                                                                                              • Slide 114
                                                                                                                                              • Slide 115
                                                                                                                                              • Intrinsic motivation
                                                                                                                                              • Slide 117
                                                                                                                                              • Slide 118
                                                                                                                                              • Slide 119
                                                                                                                                              • Metacognition
                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                              • Slide 124
                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                              • Slide 128
                                                                                                                                              • Slide 129
                                                                                                                                              • Broaden and Build
                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                              • The reward-and-planning system
                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                              • Slide 141
                                                                                                                                              • Lend Me Your Brain
                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                              • Slide 146
                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                              • Slide 149
                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                              • Slide 152
                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                              • Slide 154
                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                              • Slide 157
                                                                                                                                              • Slide 158
                                                                                                                                              • Slide 159
                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                              • Slide 162
                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                              • Slide 164
                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                              • Slide 166
                                                                                                                                              • Slide 167
                                                                                                                                              • Slide 168
                                                                                                                                              • Slide 169
                                                                                                                                              • Slide 170
                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                              • Match the Picture
                                                                                                                                              • Slide 176
                                                                                                                                              • Slide 177
                                                                                                                                              • Distraction Delay Training
                                                                                                                                              • Slide 179
                                                                                                                                              • Slide 180
                                                                                                                                              • Executive Estimates Training
                                                                                                                                              • Learning Time
                                                                                                                                              • Learning Time (2)
                                                                                                                                              • Learning Time (3)
                                                                                                                                              • Slide 185
                                                                                                                                              • Slide 186
                                                                                                                                              • Learning Time (4)
                                                                                                                                              • Asking two questionshellip
                                                                                                                                              • Slide 189
                                                                                                                                              • Slide 190
                                                                                                                                              • Key Features of Video Games
                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                              • Slide 194
                                                                                                                                              • Slide 195
                                                                                                                                              • Slide 196
                                                                                                                                              • Slide 197
                                                                                                                                              • Slide 198
                                                                                                                                              • Slide 199
                                                                                                                                              • Slide 200
                                                                                                                                              • Slide 201
                                                                                                                                              • Quarterly QI review
                                                                                                                                              • The post-mortem
                                                                                                                                              • Slide 204
                                                                                                                                              • Slide 205
                                                                                                                                              • Slide 206
                                                                                                                                              • Slide 207
                                                                                                                                              • Slide 208
                                                                                                                                              • Slide 209
                                                                                                                                              • Slide 210
                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                              • Slide 212
                                                                                                                                              • Slide 213
                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                              • Slide 215
                                                                                                                                              • Slide 216
                                                                                                                                              • Slide 217
                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                              • A challengehellip
                                                                                                                                              • Slide 222

                                                                                                                                                A B C

                                                                                                                                                antecedent

                                                                                                                                                A B C

                                                                                                                                                A B C

                                                                                                                                                antecedent

                                                                                                                                                A B C

                                                                                                                                                antecedent

                                                                                                                                                easy hard

                                                                                                                                                A B C

                                                                                                                                                consequences

                                                                                                                                                R P

                                                                                                                                                +

                                                                                                                                                -

                                                                                                                                                R+ P+

                                                                                                                                                R- P-

                                                                                                                                                Time Out

                                                                                                                                                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                Token economy

                                                                                                                                                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                Intrinsic motivation

                                                                                                                                                A B C

                                                                                                                                                consequencesX

                                                                                                                                                A B C

                                                                                                                                                behavior

                                                                                                                                                Metacognition

                                                                                                                                                Metacognitive knowledge Metacognitive strategies

                                                                                                                                                ldquoLend Me Your Brainrdquo

                                                                                                                                                What Does Dopamine Feel Like

                                                                                                                                                The Physiology of Motivation and Reward

                                                                                                                                                Preferred States What Does Dopamine Feel Like

                                                                                                                                                1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                David D Nowell PhD189 May Street

                                                                                                                                                Worcester Mass 01602DrNowellcom

                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                wwwLulucom

                                                                                                                                                Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                clusters groupings There will probably be 4 or 5

                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                Find a word a label for each of the groupings

                                                                                                                                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                Broaden and Build

                                                                                                                                                ldquoNeuroMalleabilityrdquo

                                                                                                                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                The reward-and-planning system

                                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                The reward-and-planning system

                                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                Lend Me Your Brain

                                                                                                                                                Supporting Clients with Executive Dysfunction

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                Too busy with current activity

                                                                                                                                                Field dependent

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Sequence problem-solve

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Block out distractions

                                                                                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                - E Goldberg

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Get the reward

                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                Instant gratification vs

                                                                                                                                                executive gratification

                                                                                                                                                A B C

                                                                                                                                                behaviorx

                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                takerdquordquo

                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                thathelliprdquo

                                                                                                                                                Match the Picture

                                                                                                                                                Distraction Delay Training

                                                                                                                                                Executive Estimates Training

                                                                                                                                                X

                                                                                                                                                Learning Time

                                                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                Learning Time

                                                                                                                                                Learning Time

                                                                                                                                                Learning Time

                                                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                Asking two questionshellip

                                                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                                                Am I having fun nowIs

                                                                                                                                                this

                                                                                                                                                what

                                                                                                                                                I se

                                                                                                                                                t out

                                                                                                                                                to

                                                                                                                                                do

                                                                                                                                                bullYesbullYes

                                                                                                                                                bullNobullYes

                                                                                                                                                bullYesbullNo

                                                                                                                                                bullNobullNo

                                                                                                                                                Am I having fun nowIs

                                                                                                                                                this

                                                                                                                                                what

                                                                                                                                                I se

                                                                                                                                                t out

                                                                                                                                                to

                                                                                                                                                do

                                                                                                                                                bullFunbullOn-task

                                                                                                                                                bullNot funbullOn-task

                                                                                                                                                bullFunbullNot on-task

                                                                                                                                                bullNot funbullNot on-task

                                                                                                                                                Key Features of Video Games

                                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                                Key Features of Video Games

                                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                Volkow et al 2004

                                                                                                                                                Increase salience

                                                                                                                                                Increase salience

                                                                                                                                                Quarterly QI review

                                                                                                                                                The post-mortem

                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                Yoga read

                                                                                                                                                Staff meeting

                                                                                                                                                Planningsession

                                                                                                                                                Phone calls

                                                                                                                                                billing

                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                Learn French

                                                                                                                                                Stop smoking

                                                                                                                                                Be a better spouse

                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                wwwDrNowellcom

                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                DavidNowellSeminars

                                                                                                                                                DavidNowell

                                                                                                                                                • Slide 1
                                                                                                                                                • hellipa challenge
                                                                                                                                                • Slide 3
                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                • Slide 7
                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                • Overview
                                                                                                                                                • This Dense Pudding
                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                • Slide 12
                                                                                                                                                • Slide 13
                                                                                                                                                • Developmental considerations
                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                • Slide 17
                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                • Slide 19
                                                                                                                                                • Strategies
                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                • Slide 22
                                                                                                                                                • Slide 23
                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                • Slide 25
                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                • Slide 27
                                                                                                                                                • Slide 28
                                                                                                                                                • Slide 29
                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                • CAPD or ADHD
                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                • Slide 35
                                                                                                                                                • Strategies (2)
                                                                                                                                                • (C)APD
                                                                                                                                                • Treatment for CAPD
                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                • Self-assessment
                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                • Slide 42
                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                • Core symptoms
                                                                                                                                                • Core symptoms (2)
                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                • Slide 49
                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                • Slide 53
                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                • Slide 63
                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                • ADHD and girls
                                                                                                                                                • Slide 66
                                                                                                                                                • Slide 67
                                                                                                                                                • ADHD and women
                                                                                                                                                • Slide 69
                                                                                                                                                • ADHD and women (2)
                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                • The Executive Functions
                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                • Slide 74
                                                                                                                                                • Slide 75
                                                                                                                                                • Appropriate expectations
                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                • Slide 84
                                                                                                                                                • Slide 85
                                                                                                                                                • Strategies (3)
                                                                                                                                                • Pharmacotherapy
                                                                                                                                                • Behavioral Supports
                                                                                                                                                • Slide 89
                                                                                                                                                • Slide 90
                                                                                                                                                • Slide 91
                                                                                                                                                • Slide 92
                                                                                                                                                • Slide 93
                                                                                                                                                • Slide 94
                                                                                                                                                • Slide 95
                                                                                                                                                • Slide 96
                                                                                                                                                • Slide 97
                                                                                                                                                • Slide 98
                                                                                                                                                • Slide 99
                                                                                                                                                • Slide 100
                                                                                                                                                • Slide 101
                                                                                                                                                • Slide 102
                                                                                                                                                • Slide 103
                                                                                                                                                • Slide 104
                                                                                                                                                • Slide 105
                                                                                                                                                • Slide 106
                                                                                                                                                • Slide 107
                                                                                                                                                • Slide 108
                                                                                                                                                • Slide 109
                                                                                                                                                • Slide 110
                                                                                                                                                • Time Out
                                                                                                                                                • Token economy
                                                                                                                                                • Slide 113
                                                                                                                                                • Slide 114
                                                                                                                                                • Slide 115
                                                                                                                                                • Intrinsic motivation
                                                                                                                                                • Slide 117
                                                                                                                                                • Slide 118
                                                                                                                                                • Slide 119
                                                                                                                                                • Metacognition
                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                • Slide 124
                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                • Slide 128
                                                                                                                                                • Slide 129
                                                                                                                                                • Broaden and Build
                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                • The reward-and-planning system
                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                • Slide 141
                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                • Slide 146
                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                • Slide 149
                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                • Slide 152
                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                • Slide 154
                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                • Slide 157
                                                                                                                                                • Slide 158
                                                                                                                                                • Slide 159
                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                • Slide 162
                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                • Slide 164
                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                • Slide 166
                                                                                                                                                • Slide 167
                                                                                                                                                • Slide 168
                                                                                                                                                • Slide 169
                                                                                                                                                • Slide 170
                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                • Match the Picture
                                                                                                                                                • Slide 176
                                                                                                                                                • Slide 177
                                                                                                                                                • Distraction Delay Training
                                                                                                                                                • Slide 179
                                                                                                                                                • Slide 180
                                                                                                                                                • Executive Estimates Training
                                                                                                                                                • Learning Time
                                                                                                                                                • Learning Time (2)
                                                                                                                                                • Learning Time (3)
                                                                                                                                                • Slide 185
                                                                                                                                                • Slide 186
                                                                                                                                                • Learning Time (4)
                                                                                                                                                • Asking two questionshellip
                                                                                                                                                • Slide 189
                                                                                                                                                • Slide 190
                                                                                                                                                • Key Features of Video Games
                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                • Slide 194
                                                                                                                                                • Slide 195
                                                                                                                                                • Slide 196
                                                                                                                                                • Slide 197
                                                                                                                                                • Slide 198
                                                                                                                                                • Slide 199
                                                                                                                                                • Slide 200
                                                                                                                                                • Slide 201
                                                                                                                                                • Quarterly QI review
                                                                                                                                                • The post-mortem
                                                                                                                                                • Slide 204
                                                                                                                                                • Slide 205
                                                                                                                                                • Slide 206
                                                                                                                                                • Slide 207
                                                                                                                                                • Slide 208
                                                                                                                                                • Slide 209
                                                                                                                                                • Slide 210
                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                • Slide 212
                                                                                                                                                • Slide 213
                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                • Slide 215
                                                                                                                                                • Slide 216
                                                                                                                                                • Slide 217
                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                • A challengehellip
                                                                                                                                                • Slide 222

                                                                                                                                                  A B C

                                                                                                                                                  A B C

                                                                                                                                                  antecedent

                                                                                                                                                  A B C

                                                                                                                                                  antecedent

                                                                                                                                                  easy hard

                                                                                                                                                  A B C

                                                                                                                                                  consequences

                                                                                                                                                  R P

                                                                                                                                                  +

                                                                                                                                                  -

                                                                                                                                                  R+ P+

                                                                                                                                                  R- P-

                                                                                                                                                  Time Out

                                                                                                                                                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                  Token economy

                                                                                                                                                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                  Intrinsic motivation

                                                                                                                                                  A B C

                                                                                                                                                  consequencesX

                                                                                                                                                  A B C

                                                                                                                                                  behavior

                                                                                                                                                  Metacognition

                                                                                                                                                  Metacognitive knowledge Metacognitive strategies

                                                                                                                                                  ldquoLend Me Your Brainrdquo

                                                                                                                                                  What Does Dopamine Feel Like

                                                                                                                                                  The Physiology of Motivation and Reward

                                                                                                                                                  Preferred States What Does Dopamine Feel Like

                                                                                                                                                  1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                  David D Nowell PhD189 May Street

                                                                                                                                                  Worcester Mass 01602DrNowellcom

                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                  wwwLulucom

                                                                                                                                                  Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                  of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                  clusters groupings There will probably be 4 or 5

                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                  Find a word a label for each of the groupings

                                                                                                                                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                  ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                  Broaden and Build

                                                                                                                                                  ldquoNeuroMalleabilityrdquo

                                                                                                                                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                  The reward-and-planning system

                                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                  The reward-and-planning system

                                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                  Lend Me Your Brain

                                                                                                                                                  Supporting Clients with Executive Dysfunction

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                  Too busy with current activity

                                                                                                                                                  Field dependent

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Sequence problem-solve

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Block out distractions

                                                                                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                  - E Goldberg

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Get the reward

                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                  Instant gratification vs

                                                                                                                                                  executive gratification

                                                                                                                                                  A B C

                                                                                                                                                  behaviorx

                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                  takerdquordquo

                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                  thathelliprdquo

                                                                                                                                                  Match the Picture

                                                                                                                                                  Distraction Delay Training

                                                                                                                                                  Executive Estimates Training

                                                                                                                                                  X

                                                                                                                                                  Learning Time

                                                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                  Learning Time

                                                                                                                                                  Learning Time

                                                                                                                                                  Learning Time

                                                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                  Asking two questionshellip

                                                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                  this

                                                                                                                                                  what

                                                                                                                                                  I se

                                                                                                                                                  t out

                                                                                                                                                  to

                                                                                                                                                  do

                                                                                                                                                  bullYesbullYes

                                                                                                                                                  bullNobullYes

                                                                                                                                                  bullYesbullNo

                                                                                                                                                  bullNobullNo

                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                  this

                                                                                                                                                  what

                                                                                                                                                  I se

                                                                                                                                                  t out

                                                                                                                                                  to

                                                                                                                                                  do

                                                                                                                                                  bullFunbullOn-task

                                                                                                                                                  bullNot funbullOn-task

                                                                                                                                                  bullFunbullNot on-task

                                                                                                                                                  bullNot funbullNot on-task

                                                                                                                                                  Key Features of Video Games

                                                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                                                  Key Features of Video Games

                                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                  Volkow et al 2004

                                                                                                                                                  Increase salience

                                                                                                                                                  Increase salience

                                                                                                                                                  Quarterly QI review

                                                                                                                                                  The post-mortem

                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                  Yoga read

                                                                                                                                                  Staff meeting

                                                                                                                                                  Planningsession

                                                                                                                                                  Phone calls

                                                                                                                                                  billing

                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                  Learn French

                                                                                                                                                  Stop smoking

                                                                                                                                                  Be a better spouse

                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                  DavidNowell

                                                                                                                                                  • Slide 1
                                                                                                                                                  • hellipa challenge
                                                                                                                                                  • Slide 3
                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                  • Slide 7
                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                  • Overview
                                                                                                                                                  • This Dense Pudding
                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                  • Slide 12
                                                                                                                                                  • Slide 13
                                                                                                                                                  • Developmental considerations
                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                  • Slide 17
                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                  • Slide 19
                                                                                                                                                  • Strategies
                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                  • Slide 22
                                                                                                                                                  • Slide 23
                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                  • Slide 25
                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                  • Slide 27
                                                                                                                                                  • Slide 28
                                                                                                                                                  • Slide 29
                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                  • Slide 35
                                                                                                                                                  • Strategies (2)
                                                                                                                                                  • (C)APD
                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                  • Self-assessment
                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                  • Slide 42
                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                  • Core symptoms
                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                  • Slide 49
                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                  • Slide 53
                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                  • Slide 63
                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                  • ADHD and girls
                                                                                                                                                  • Slide 66
                                                                                                                                                  • Slide 67
                                                                                                                                                  • ADHD and women
                                                                                                                                                  • Slide 69
                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                  • The Executive Functions
                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                  • Slide 74
                                                                                                                                                  • Slide 75
                                                                                                                                                  • Appropriate expectations
                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                  • Slide 84
                                                                                                                                                  • Slide 85
                                                                                                                                                  • Strategies (3)
                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                  • Behavioral Supports
                                                                                                                                                  • Slide 89
                                                                                                                                                  • Slide 90
                                                                                                                                                  • Slide 91
                                                                                                                                                  • Slide 92
                                                                                                                                                  • Slide 93
                                                                                                                                                  • Slide 94
                                                                                                                                                  • Slide 95
                                                                                                                                                  • Slide 96
                                                                                                                                                  • Slide 97
                                                                                                                                                  • Slide 98
                                                                                                                                                  • Slide 99
                                                                                                                                                  • Slide 100
                                                                                                                                                  • Slide 101
                                                                                                                                                  • Slide 102
                                                                                                                                                  • Slide 103
                                                                                                                                                  • Slide 104
                                                                                                                                                  • Slide 105
                                                                                                                                                  • Slide 106
                                                                                                                                                  • Slide 107
                                                                                                                                                  • Slide 108
                                                                                                                                                  • Slide 109
                                                                                                                                                  • Slide 110
                                                                                                                                                  • Time Out
                                                                                                                                                  • Token economy
                                                                                                                                                  • Slide 113
                                                                                                                                                  • Slide 114
                                                                                                                                                  • Slide 115
                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                  • Slide 117
                                                                                                                                                  • Slide 118
                                                                                                                                                  • Slide 119
                                                                                                                                                  • Metacognition
                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                  • Slide 124
                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                  • Slide 128
                                                                                                                                                  • Slide 129
                                                                                                                                                  • Broaden and Build
                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                  • Slide 141
                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                  • Slide 146
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                  • Slide 149
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                  • Slide 152
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                  • Slide 154
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                  • Slide 157
                                                                                                                                                  • Slide 158
                                                                                                                                                  • Slide 159
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                  • Slide 162
                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                  • Slide 164
                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                  • Slide 166
                                                                                                                                                  • Slide 167
                                                                                                                                                  • Slide 168
                                                                                                                                                  • Slide 169
                                                                                                                                                  • Slide 170
                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                  • Match the Picture
                                                                                                                                                  • Slide 176
                                                                                                                                                  • Slide 177
                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                  • Slide 179
                                                                                                                                                  • Slide 180
                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                  • Learning Time
                                                                                                                                                  • Learning Time (2)
                                                                                                                                                  • Learning Time (3)
                                                                                                                                                  • Slide 185
                                                                                                                                                  • Slide 186
                                                                                                                                                  • Learning Time (4)
                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                  • Slide 189
                                                                                                                                                  • Slide 190
                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                  • Slide 194
                                                                                                                                                  • Slide 195
                                                                                                                                                  • Slide 196
                                                                                                                                                  • Slide 197
                                                                                                                                                  • Slide 198
                                                                                                                                                  • Slide 199
                                                                                                                                                  • Slide 200
                                                                                                                                                  • Slide 201
                                                                                                                                                  • Quarterly QI review
                                                                                                                                                  • The post-mortem
                                                                                                                                                  • Slide 204
                                                                                                                                                  • Slide 205
                                                                                                                                                  • Slide 206
                                                                                                                                                  • Slide 207
                                                                                                                                                  • Slide 208
                                                                                                                                                  • Slide 209
                                                                                                                                                  • Slide 210
                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                  • Slide 212
                                                                                                                                                  • Slide 213
                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                  • Slide 215
                                                                                                                                                  • Slide 216
                                                                                                                                                  • Slide 217
                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                  • A challengehellip
                                                                                                                                                  • Slide 222

                                                                                                                                                    A B C

                                                                                                                                                    antecedent

                                                                                                                                                    A B C

                                                                                                                                                    antecedent

                                                                                                                                                    easy hard

                                                                                                                                                    A B C

                                                                                                                                                    consequences

                                                                                                                                                    R P

                                                                                                                                                    +

                                                                                                                                                    -

                                                                                                                                                    R+ P+

                                                                                                                                                    R- P-

                                                                                                                                                    Time Out

                                                                                                                                                    Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                    Token economy

                                                                                                                                                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                    Intrinsic motivation

                                                                                                                                                    A B C

                                                                                                                                                    consequencesX

                                                                                                                                                    A B C

                                                                                                                                                    behavior

                                                                                                                                                    Metacognition

                                                                                                                                                    Metacognitive knowledge Metacognitive strategies

                                                                                                                                                    ldquoLend Me Your Brainrdquo

                                                                                                                                                    What Does Dopamine Feel Like

                                                                                                                                                    The Physiology of Motivation and Reward

                                                                                                                                                    Preferred States What Does Dopamine Feel Like

                                                                                                                                                    1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                    David D Nowell PhD189 May Street

                                                                                                                                                    Worcester Mass 01602DrNowellcom

                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                    wwwLulucom

                                                                                                                                                    Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                    of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                    clusters groupings There will probably be 4 or 5

                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                    Find a word a label for each of the groupings

                                                                                                                                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                    ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                    Broaden and Build

                                                                                                                                                    ldquoNeuroMalleabilityrdquo

                                                                                                                                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                    The reward-and-planning system

                                                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                    The reward-and-planning system

                                                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                    Lend Me Your Brain

                                                                                                                                                    Supporting Clients with Executive Dysfunction

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                    Too busy with current activity

                                                                                                                                                    Field dependent

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Sequence problem-solve

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Block out distractions

                                                                                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                    - E Goldberg

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Get the reward

                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                    Instant gratification vs

                                                                                                                                                    executive gratification

                                                                                                                                                    A B C

                                                                                                                                                    behaviorx

                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                    takerdquordquo

                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                    thathelliprdquo

                                                                                                                                                    Match the Picture

                                                                                                                                                    Distraction Delay Training

                                                                                                                                                    Executive Estimates Training

                                                                                                                                                    X

                                                                                                                                                    Learning Time

                                                                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                    Learning Time

                                                                                                                                                    Learning Time

                                                                                                                                                    Learning Time

                                                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                    Asking two questionshellip

                                                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                    this

                                                                                                                                                    what

                                                                                                                                                    I se

                                                                                                                                                    t out

                                                                                                                                                    to

                                                                                                                                                    do

                                                                                                                                                    bullYesbullYes

                                                                                                                                                    bullNobullYes

                                                                                                                                                    bullYesbullNo

                                                                                                                                                    bullNobullNo

                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                    this

                                                                                                                                                    what

                                                                                                                                                    I se

                                                                                                                                                    t out

                                                                                                                                                    to

                                                                                                                                                    do

                                                                                                                                                    bullFunbullOn-task

                                                                                                                                                    bullNot funbullOn-task

                                                                                                                                                    bullFunbullNot on-task

                                                                                                                                                    bullNot funbullNot on-task

                                                                                                                                                    Key Features of Video Games

                                                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                                                    Key Features of Video Games

                                                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                    Volkow et al 2004

                                                                                                                                                    Increase salience

                                                                                                                                                    Increase salience

                                                                                                                                                    Quarterly QI review

                                                                                                                                                    The post-mortem

                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                    Yoga read

                                                                                                                                                    Staff meeting

                                                                                                                                                    Planningsession

                                                                                                                                                    Phone calls

                                                                                                                                                    billing

                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                    Learn French

                                                                                                                                                    Stop smoking

                                                                                                                                                    Be a better spouse

                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                    DavidNowell

                                                                                                                                                    • Slide 1
                                                                                                                                                    • hellipa challenge
                                                                                                                                                    • Slide 3
                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                    • Slide 7
                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                    • Overview
                                                                                                                                                    • This Dense Pudding
                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                    • Slide 12
                                                                                                                                                    • Slide 13
                                                                                                                                                    • Developmental considerations
                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                    • Slide 17
                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                    • Slide 19
                                                                                                                                                    • Strategies
                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                    • Slide 22
                                                                                                                                                    • Slide 23
                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                    • Slide 25
                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                    • Slide 27
                                                                                                                                                    • Slide 28
                                                                                                                                                    • Slide 29
                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                    • Slide 35
                                                                                                                                                    • Strategies (2)
                                                                                                                                                    • (C)APD
                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                    • Self-assessment
                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                    • Slide 42
                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                    • Core symptoms
                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                    • Slide 49
                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                    • Slide 53
                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                    • Slide 63
                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                    • ADHD and girls
                                                                                                                                                    • Slide 66
                                                                                                                                                    • Slide 67
                                                                                                                                                    • ADHD and women
                                                                                                                                                    • Slide 69
                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                    • The Executive Functions
                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                    • Slide 74
                                                                                                                                                    • Slide 75
                                                                                                                                                    • Appropriate expectations
                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                    • Slide 84
                                                                                                                                                    • Slide 85
                                                                                                                                                    • Strategies (3)
                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                    • Behavioral Supports
                                                                                                                                                    • Slide 89
                                                                                                                                                    • Slide 90
                                                                                                                                                    • Slide 91
                                                                                                                                                    • Slide 92
                                                                                                                                                    • Slide 93
                                                                                                                                                    • Slide 94
                                                                                                                                                    • Slide 95
                                                                                                                                                    • Slide 96
                                                                                                                                                    • Slide 97
                                                                                                                                                    • Slide 98
                                                                                                                                                    • Slide 99
                                                                                                                                                    • Slide 100
                                                                                                                                                    • Slide 101
                                                                                                                                                    • Slide 102
                                                                                                                                                    • Slide 103
                                                                                                                                                    • Slide 104
                                                                                                                                                    • Slide 105
                                                                                                                                                    • Slide 106
                                                                                                                                                    • Slide 107
                                                                                                                                                    • Slide 108
                                                                                                                                                    • Slide 109
                                                                                                                                                    • Slide 110
                                                                                                                                                    • Time Out
                                                                                                                                                    • Token economy
                                                                                                                                                    • Slide 113
                                                                                                                                                    • Slide 114
                                                                                                                                                    • Slide 115
                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                    • Slide 117
                                                                                                                                                    • Slide 118
                                                                                                                                                    • Slide 119
                                                                                                                                                    • Metacognition
                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                    • Slide 124
                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                    • Slide 128
                                                                                                                                                    • Slide 129
                                                                                                                                                    • Broaden and Build
                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                    • Slide 141
                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                    • Slide 146
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                    • Slide 149
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                    • Slide 152
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                    • Slide 154
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                    • Slide 157
                                                                                                                                                    • Slide 158
                                                                                                                                                    • Slide 159
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                    • Slide 162
                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                    • Slide 164
                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                    • Slide 166
                                                                                                                                                    • Slide 167
                                                                                                                                                    • Slide 168
                                                                                                                                                    • Slide 169
                                                                                                                                                    • Slide 170
                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                    • Match the Picture
                                                                                                                                                    • Slide 176
                                                                                                                                                    • Slide 177
                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                    • Slide 179
                                                                                                                                                    • Slide 180
                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                    • Learning Time
                                                                                                                                                    • Learning Time (2)
                                                                                                                                                    • Learning Time (3)
                                                                                                                                                    • Slide 185
                                                                                                                                                    • Slide 186
                                                                                                                                                    • Learning Time (4)
                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                    • Slide 189
                                                                                                                                                    • Slide 190
                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                    • Slide 194
                                                                                                                                                    • Slide 195
                                                                                                                                                    • Slide 196
                                                                                                                                                    • Slide 197
                                                                                                                                                    • Slide 198
                                                                                                                                                    • Slide 199
                                                                                                                                                    • Slide 200
                                                                                                                                                    • Slide 201
                                                                                                                                                    • Quarterly QI review
                                                                                                                                                    • The post-mortem
                                                                                                                                                    • Slide 204
                                                                                                                                                    • Slide 205
                                                                                                                                                    • Slide 206
                                                                                                                                                    • Slide 207
                                                                                                                                                    • Slide 208
                                                                                                                                                    • Slide 209
                                                                                                                                                    • Slide 210
                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                    • Slide 212
                                                                                                                                                    • Slide 213
                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                    • Slide 215
                                                                                                                                                    • Slide 216
                                                                                                                                                    • Slide 217
                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                    • A challengehellip
                                                                                                                                                    • Slide 222

                                                                                                                                                      A B C

                                                                                                                                                      antecedent

                                                                                                                                                      easy hard

                                                                                                                                                      A B C

                                                                                                                                                      consequences

                                                                                                                                                      R P

                                                                                                                                                      +

                                                                                                                                                      -

                                                                                                                                                      R+ P+

                                                                                                                                                      R- P-

                                                                                                                                                      Time Out

                                                                                                                                                      Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                      Token economy

                                                                                                                                                      Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                      Intrinsic motivation

                                                                                                                                                      A B C

                                                                                                                                                      consequencesX

                                                                                                                                                      A B C

                                                                                                                                                      behavior

                                                                                                                                                      Metacognition

                                                                                                                                                      Metacognitive knowledge Metacognitive strategies

                                                                                                                                                      ldquoLend Me Your Brainrdquo

                                                                                                                                                      What Does Dopamine Feel Like

                                                                                                                                                      The Physiology of Motivation and Reward

                                                                                                                                                      Preferred States What Does Dopamine Feel Like

                                                                                                                                                      1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                      David D Nowell PhD189 May Street

                                                                                                                                                      Worcester Mass 01602DrNowellcom

                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                      wwwLulucom

                                                                                                                                                      Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                      of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                      clusters groupings There will probably be 4 or 5

                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                      Find a word a label for each of the groupings

                                                                                                                                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                      ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                      Broaden and Build

                                                                                                                                                      ldquoNeuroMalleabilityrdquo

                                                                                                                                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                      The reward-and-planning system

                                                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                      The reward-and-planning system

                                                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                      Lend Me Your Brain

                                                                                                                                                      Supporting Clients with Executive Dysfunction

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                      Too busy with current activity

                                                                                                                                                      Field dependent

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Sequence problem-solve

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Block out distractions

                                                                                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                      - E Goldberg

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Get the reward

                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                      Instant gratification vs

                                                                                                                                                      executive gratification

                                                                                                                                                      A B C

                                                                                                                                                      behaviorx

                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                      takerdquordquo

                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                      thathelliprdquo

                                                                                                                                                      Match the Picture

                                                                                                                                                      Distraction Delay Training

                                                                                                                                                      Executive Estimates Training

                                                                                                                                                      X

                                                                                                                                                      Learning Time

                                                                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                      Learning Time

                                                                                                                                                      Learning Time

                                                                                                                                                      Learning Time

                                                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                      Asking two questionshellip

                                                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                      this

                                                                                                                                                      what

                                                                                                                                                      I se

                                                                                                                                                      t out

                                                                                                                                                      to

                                                                                                                                                      do

                                                                                                                                                      bullYesbullYes

                                                                                                                                                      bullNobullYes

                                                                                                                                                      bullYesbullNo

                                                                                                                                                      bullNobullNo

                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                      this

                                                                                                                                                      what

                                                                                                                                                      I se

                                                                                                                                                      t out

                                                                                                                                                      to

                                                                                                                                                      do

                                                                                                                                                      bullFunbullOn-task

                                                                                                                                                      bullNot funbullOn-task

                                                                                                                                                      bullFunbullNot on-task

                                                                                                                                                      bullNot funbullNot on-task

                                                                                                                                                      Key Features of Video Games

                                                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                                                      Key Features of Video Games

                                                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                      Volkow et al 2004

                                                                                                                                                      Increase salience

                                                                                                                                                      Increase salience

                                                                                                                                                      Quarterly QI review

                                                                                                                                                      The post-mortem

                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                      Yoga read

                                                                                                                                                      Staff meeting

                                                                                                                                                      Planningsession

                                                                                                                                                      Phone calls

                                                                                                                                                      billing

                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                      Learn French

                                                                                                                                                      Stop smoking

                                                                                                                                                      Be a better spouse

                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                      DavidNowell

                                                                                                                                                      • Slide 1
                                                                                                                                                      • hellipa challenge
                                                                                                                                                      • Slide 3
                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                      • Slide 7
                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                      • Overview
                                                                                                                                                      • This Dense Pudding
                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                      • Slide 12
                                                                                                                                                      • Slide 13
                                                                                                                                                      • Developmental considerations
                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                      • Slide 17
                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                      • Slide 19
                                                                                                                                                      • Strategies
                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                      • Slide 22
                                                                                                                                                      • Slide 23
                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                      • Slide 25
                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                      • Slide 27
                                                                                                                                                      • Slide 28
                                                                                                                                                      • Slide 29
                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                      • Slide 35
                                                                                                                                                      • Strategies (2)
                                                                                                                                                      • (C)APD
                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                      • Self-assessment
                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                      • Slide 42
                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                      • Core symptoms
                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                      • Slide 49
                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                      • Slide 53
                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                      • Slide 63
                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                      • ADHD and girls
                                                                                                                                                      • Slide 66
                                                                                                                                                      • Slide 67
                                                                                                                                                      • ADHD and women
                                                                                                                                                      • Slide 69
                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                      • The Executive Functions
                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                      • Slide 74
                                                                                                                                                      • Slide 75
                                                                                                                                                      • Appropriate expectations
                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                      • Slide 84
                                                                                                                                                      • Slide 85
                                                                                                                                                      • Strategies (3)
                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                      • Behavioral Supports
                                                                                                                                                      • Slide 89
                                                                                                                                                      • Slide 90
                                                                                                                                                      • Slide 91
                                                                                                                                                      • Slide 92
                                                                                                                                                      • Slide 93
                                                                                                                                                      • Slide 94
                                                                                                                                                      • Slide 95
                                                                                                                                                      • Slide 96
                                                                                                                                                      • Slide 97
                                                                                                                                                      • Slide 98
                                                                                                                                                      • Slide 99
                                                                                                                                                      • Slide 100
                                                                                                                                                      • Slide 101
                                                                                                                                                      • Slide 102
                                                                                                                                                      • Slide 103
                                                                                                                                                      • Slide 104
                                                                                                                                                      • Slide 105
                                                                                                                                                      • Slide 106
                                                                                                                                                      • Slide 107
                                                                                                                                                      • Slide 108
                                                                                                                                                      • Slide 109
                                                                                                                                                      • Slide 110
                                                                                                                                                      • Time Out
                                                                                                                                                      • Token economy
                                                                                                                                                      • Slide 113
                                                                                                                                                      • Slide 114
                                                                                                                                                      • Slide 115
                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                      • Slide 117
                                                                                                                                                      • Slide 118
                                                                                                                                                      • Slide 119
                                                                                                                                                      • Metacognition
                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                      • Slide 124
                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                      • Slide 128
                                                                                                                                                      • Slide 129
                                                                                                                                                      • Broaden and Build
                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                      • Slide 141
                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                      • Slide 146
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                      • Slide 149
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                      • Slide 152
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                      • Slide 154
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                      • Slide 157
                                                                                                                                                      • Slide 158
                                                                                                                                                      • Slide 159
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                      • Slide 162
                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                      • Slide 164
                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                      • Slide 166
                                                                                                                                                      • Slide 167
                                                                                                                                                      • Slide 168
                                                                                                                                                      • Slide 169
                                                                                                                                                      • Slide 170
                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                      • Match the Picture
                                                                                                                                                      • Slide 176
                                                                                                                                                      • Slide 177
                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                      • Slide 179
                                                                                                                                                      • Slide 180
                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                      • Learning Time
                                                                                                                                                      • Learning Time (2)
                                                                                                                                                      • Learning Time (3)
                                                                                                                                                      • Slide 185
                                                                                                                                                      • Slide 186
                                                                                                                                                      • Learning Time (4)
                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                      • Slide 189
                                                                                                                                                      • Slide 190
                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                      • Slide 194
                                                                                                                                                      • Slide 195
                                                                                                                                                      • Slide 196
                                                                                                                                                      • Slide 197
                                                                                                                                                      • Slide 198
                                                                                                                                                      • Slide 199
                                                                                                                                                      • Slide 200
                                                                                                                                                      • Slide 201
                                                                                                                                                      • Quarterly QI review
                                                                                                                                                      • The post-mortem
                                                                                                                                                      • Slide 204
                                                                                                                                                      • Slide 205
                                                                                                                                                      • Slide 206
                                                                                                                                                      • Slide 207
                                                                                                                                                      • Slide 208
                                                                                                                                                      • Slide 209
                                                                                                                                                      • Slide 210
                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                      • Slide 212
                                                                                                                                                      • Slide 213
                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                      • Slide 215
                                                                                                                                                      • Slide 216
                                                                                                                                                      • Slide 217
                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                      • A challengehellip
                                                                                                                                                      • Slide 222

                                                                                                                                                        easy hard

                                                                                                                                                        A B C

                                                                                                                                                        consequences

                                                                                                                                                        R P

                                                                                                                                                        +

                                                                                                                                                        -

                                                                                                                                                        R+ P+

                                                                                                                                                        R- P-

                                                                                                                                                        Time Out

                                                                                                                                                        Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                        Token economy

                                                                                                                                                        Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                        Intrinsic motivation

                                                                                                                                                        A B C

                                                                                                                                                        consequencesX

                                                                                                                                                        A B C

                                                                                                                                                        behavior

                                                                                                                                                        Metacognition

                                                                                                                                                        Metacognitive knowledge Metacognitive strategies

                                                                                                                                                        ldquoLend Me Your Brainrdquo

                                                                                                                                                        What Does Dopamine Feel Like

                                                                                                                                                        The Physiology of Motivation and Reward

                                                                                                                                                        Preferred States What Does Dopamine Feel Like

                                                                                                                                                        1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                        David D Nowell PhD189 May Street

                                                                                                                                                        Worcester Mass 01602DrNowellcom

                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                        wwwLulucom

                                                                                                                                                        Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                        of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                        clusters groupings There will probably be 4 or 5

                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                        Find a word a label for each of the groupings

                                                                                                                                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                        ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                        Broaden and Build

                                                                                                                                                        ldquoNeuroMalleabilityrdquo

                                                                                                                                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                        The reward-and-planning system

                                                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                        The reward-and-planning system

                                                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                        Lend Me Your Brain

                                                                                                                                                        Supporting Clients with Executive Dysfunction

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                        Too busy with current activity

                                                                                                                                                        Field dependent

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Sequence problem-solve

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Block out distractions

                                                                                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                        - E Goldberg

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Get the reward

                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                        Instant gratification vs

                                                                                                                                                        executive gratification

                                                                                                                                                        A B C

                                                                                                                                                        behaviorx

                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                        takerdquordquo

                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                        thathelliprdquo

                                                                                                                                                        Match the Picture

                                                                                                                                                        Distraction Delay Training

                                                                                                                                                        Executive Estimates Training

                                                                                                                                                        X

                                                                                                                                                        Learning Time

                                                                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                        Learning Time

                                                                                                                                                        Learning Time

                                                                                                                                                        Learning Time

                                                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                        Asking two questionshellip

                                                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                        this

                                                                                                                                                        what

                                                                                                                                                        I se

                                                                                                                                                        t out

                                                                                                                                                        to

                                                                                                                                                        do

                                                                                                                                                        bullYesbullYes

                                                                                                                                                        bullNobullYes

                                                                                                                                                        bullYesbullNo

                                                                                                                                                        bullNobullNo

                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                        this

                                                                                                                                                        what

                                                                                                                                                        I se

                                                                                                                                                        t out

                                                                                                                                                        to

                                                                                                                                                        do

                                                                                                                                                        bullFunbullOn-task

                                                                                                                                                        bullNot funbullOn-task

                                                                                                                                                        bullFunbullNot on-task

                                                                                                                                                        bullNot funbullNot on-task

                                                                                                                                                        Key Features of Video Games

                                                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                                                        Key Features of Video Games

                                                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                        Volkow et al 2004

                                                                                                                                                        Increase salience

                                                                                                                                                        Increase salience

                                                                                                                                                        Quarterly QI review

                                                                                                                                                        The post-mortem

                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                        Yoga read

                                                                                                                                                        Staff meeting

                                                                                                                                                        Planningsession

                                                                                                                                                        Phone calls

                                                                                                                                                        billing

                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                        Learn French

                                                                                                                                                        Stop smoking

                                                                                                                                                        Be a better spouse

                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                        DavidNowell

                                                                                                                                                        • Slide 1
                                                                                                                                                        • hellipa challenge
                                                                                                                                                        • Slide 3
                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                        • Slide 7
                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                        • Overview
                                                                                                                                                        • This Dense Pudding
                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                        • Slide 12
                                                                                                                                                        • Slide 13
                                                                                                                                                        • Developmental considerations
                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                        • Slide 17
                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                        • Slide 19
                                                                                                                                                        • Strategies
                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                        • Slide 22
                                                                                                                                                        • Slide 23
                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                        • Slide 25
                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                        • Slide 27
                                                                                                                                                        • Slide 28
                                                                                                                                                        • Slide 29
                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                        • Slide 35
                                                                                                                                                        • Strategies (2)
                                                                                                                                                        • (C)APD
                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                        • Self-assessment
                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                        • Slide 42
                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                        • Core symptoms
                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                        • Slide 49
                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                        • Slide 53
                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                        • Slide 63
                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                        • ADHD and girls
                                                                                                                                                        • Slide 66
                                                                                                                                                        • Slide 67
                                                                                                                                                        • ADHD and women
                                                                                                                                                        • Slide 69
                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                        • The Executive Functions
                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                        • Slide 74
                                                                                                                                                        • Slide 75
                                                                                                                                                        • Appropriate expectations
                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                        • Slide 84
                                                                                                                                                        • Slide 85
                                                                                                                                                        • Strategies (3)
                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                        • Behavioral Supports
                                                                                                                                                        • Slide 89
                                                                                                                                                        • Slide 90
                                                                                                                                                        • Slide 91
                                                                                                                                                        • Slide 92
                                                                                                                                                        • Slide 93
                                                                                                                                                        • Slide 94
                                                                                                                                                        • Slide 95
                                                                                                                                                        • Slide 96
                                                                                                                                                        • Slide 97
                                                                                                                                                        • Slide 98
                                                                                                                                                        • Slide 99
                                                                                                                                                        • Slide 100
                                                                                                                                                        • Slide 101
                                                                                                                                                        • Slide 102
                                                                                                                                                        • Slide 103
                                                                                                                                                        • Slide 104
                                                                                                                                                        • Slide 105
                                                                                                                                                        • Slide 106
                                                                                                                                                        • Slide 107
                                                                                                                                                        • Slide 108
                                                                                                                                                        • Slide 109
                                                                                                                                                        • Slide 110
                                                                                                                                                        • Time Out
                                                                                                                                                        • Token economy
                                                                                                                                                        • Slide 113
                                                                                                                                                        • Slide 114
                                                                                                                                                        • Slide 115
                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                        • Slide 117
                                                                                                                                                        • Slide 118
                                                                                                                                                        • Slide 119
                                                                                                                                                        • Metacognition
                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                        • Slide 124
                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                        • Slide 128
                                                                                                                                                        • Slide 129
                                                                                                                                                        • Broaden and Build
                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                        • Slide 141
                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                        • Slide 146
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                        • Slide 149
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                        • Slide 152
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                        • Slide 154
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                        • Slide 157
                                                                                                                                                        • Slide 158
                                                                                                                                                        • Slide 159
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                        • Slide 162
                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                        • Slide 164
                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                        • Slide 166
                                                                                                                                                        • Slide 167
                                                                                                                                                        • Slide 168
                                                                                                                                                        • Slide 169
                                                                                                                                                        • Slide 170
                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                        • Match the Picture
                                                                                                                                                        • Slide 176
                                                                                                                                                        • Slide 177
                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                        • Slide 179
                                                                                                                                                        • Slide 180
                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                        • Learning Time
                                                                                                                                                        • Learning Time (2)
                                                                                                                                                        • Learning Time (3)
                                                                                                                                                        • Slide 185
                                                                                                                                                        • Slide 186
                                                                                                                                                        • Learning Time (4)
                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                        • Slide 189
                                                                                                                                                        • Slide 190
                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                        • Slide 194
                                                                                                                                                        • Slide 195
                                                                                                                                                        • Slide 196
                                                                                                                                                        • Slide 197
                                                                                                                                                        • Slide 198
                                                                                                                                                        • Slide 199
                                                                                                                                                        • Slide 200
                                                                                                                                                        • Slide 201
                                                                                                                                                        • Quarterly QI review
                                                                                                                                                        • The post-mortem
                                                                                                                                                        • Slide 204
                                                                                                                                                        • Slide 205
                                                                                                                                                        • Slide 206
                                                                                                                                                        • Slide 207
                                                                                                                                                        • Slide 208
                                                                                                                                                        • Slide 209
                                                                                                                                                        • Slide 210
                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                        • Slide 212
                                                                                                                                                        • Slide 213
                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                        • Slide 215
                                                                                                                                                        • Slide 216
                                                                                                                                                        • Slide 217
                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                        • A challengehellip
                                                                                                                                                        • Slide 222

                                                                                                                                                          A B C

                                                                                                                                                          consequences

                                                                                                                                                          R P

                                                                                                                                                          +

                                                                                                                                                          -

                                                                                                                                                          R+ P+

                                                                                                                                                          R- P-

                                                                                                                                                          Time Out

                                                                                                                                                          Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                          Token economy

                                                                                                                                                          Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                          Intrinsic motivation

                                                                                                                                                          A B C

                                                                                                                                                          consequencesX

                                                                                                                                                          A B C

                                                                                                                                                          behavior

                                                                                                                                                          Metacognition

                                                                                                                                                          Metacognitive knowledge Metacognitive strategies

                                                                                                                                                          ldquoLend Me Your Brainrdquo

                                                                                                                                                          What Does Dopamine Feel Like

                                                                                                                                                          The Physiology of Motivation and Reward

                                                                                                                                                          Preferred States What Does Dopamine Feel Like

                                                                                                                                                          1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                          David D Nowell PhD189 May Street

                                                                                                                                                          Worcester Mass 01602DrNowellcom

                                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                                          wwwLulucom

                                                                                                                                                          Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                          of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                          clusters groupings There will probably be 4 or 5

                                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                                          Find a word a label for each of the groupings

                                                                                                                                                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                          ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                                          Broaden and Build

                                                                                                                                                          ldquoNeuroMalleabilityrdquo

                                                                                                                                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                          The reward-and-planning system

                                                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                          The reward-and-planning system

                                                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                          Lend Me Your Brain

                                                                                                                                                          Supporting Clients with Executive Dysfunction

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                          Too busy with current activity

                                                                                                                                                          Field dependent

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Sequence problem-solve

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Block out distractions

                                                                                                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                          - E Goldberg

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Get the reward

                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                          Instant gratification vs

                                                                                                                                                          executive gratification

                                                                                                                                                          A B C

                                                                                                                                                          behaviorx

                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                          takerdquordquo

                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                          thathelliprdquo

                                                                                                                                                          Match the Picture

                                                                                                                                                          Distraction Delay Training

                                                                                                                                                          Executive Estimates Training

                                                                                                                                                          X

                                                                                                                                                          Learning Time

                                                                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                          Learning Time

                                                                                                                                                          Learning Time

                                                                                                                                                          Learning Time

                                                                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                          Asking two questionshellip

                                                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                          this

                                                                                                                                                          what

                                                                                                                                                          I se

                                                                                                                                                          t out

                                                                                                                                                          to

                                                                                                                                                          do

                                                                                                                                                          bullYesbullYes

                                                                                                                                                          bullNobullYes

                                                                                                                                                          bullYesbullNo

                                                                                                                                                          bullNobullNo

                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                          this

                                                                                                                                                          what

                                                                                                                                                          I se

                                                                                                                                                          t out

                                                                                                                                                          to

                                                                                                                                                          do

                                                                                                                                                          bullFunbullOn-task

                                                                                                                                                          bullNot funbullOn-task

                                                                                                                                                          bullFunbullNot on-task

                                                                                                                                                          bullNot funbullNot on-task

                                                                                                                                                          Key Features of Video Games

                                                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                                                          Key Features of Video Games

                                                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                          Volkow et al 2004

                                                                                                                                                          Increase salience

                                                                                                                                                          Increase salience

                                                                                                                                                          Quarterly QI review

                                                                                                                                                          The post-mortem

                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                          Yoga read

                                                                                                                                                          Staff meeting

                                                                                                                                                          Planningsession

                                                                                                                                                          Phone calls

                                                                                                                                                          billing

                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                          Learn French

                                                                                                                                                          Stop smoking

                                                                                                                                                          Be a better spouse

                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                          DavidNowell

                                                                                                                                                          • Slide 1
                                                                                                                                                          • hellipa challenge
                                                                                                                                                          • Slide 3
                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                          • Slide 7
                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                          • Overview
                                                                                                                                                          • This Dense Pudding
                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                          • Slide 12
                                                                                                                                                          • Slide 13
                                                                                                                                                          • Developmental considerations
                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                          • Slide 17
                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                          • Slide 19
                                                                                                                                                          • Strategies
                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                          • Slide 22
                                                                                                                                                          • Slide 23
                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                          • Slide 25
                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                          • Slide 27
                                                                                                                                                          • Slide 28
                                                                                                                                                          • Slide 29
                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                          • Slide 35
                                                                                                                                                          • Strategies (2)
                                                                                                                                                          • (C)APD
                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                          • Self-assessment
                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                          • Slide 42
                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                          • Core symptoms
                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                          • Slide 49
                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                          • Slide 53
                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                          • Slide 63
                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                          • ADHD and girls
                                                                                                                                                          • Slide 66
                                                                                                                                                          • Slide 67
                                                                                                                                                          • ADHD and women
                                                                                                                                                          • Slide 69
                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                          • The Executive Functions
                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                          • Slide 74
                                                                                                                                                          • Slide 75
                                                                                                                                                          • Appropriate expectations
                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                          • Slide 84
                                                                                                                                                          • Slide 85
                                                                                                                                                          • Strategies (3)
                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                          • Behavioral Supports
                                                                                                                                                          • Slide 89
                                                                                                                                                          • Slide 90
                                                                                                                                                          • Slide 91
                                                                                                                                                          • Slide 92
                                                                                                                                                          • Slide 93
                                                                                                                                                          • Slide 94
                                                                                                                                                          • Slide 95
                                                                                                                                                          • Slide 96
                                                                                                                                                          • Slide 97
                                                                                                                                                          • Slide 98
                                                                                                                                                          • Slide 99
                                                                                                                                                          • Slide 100
                                                                                                                                                          • Slide 101
                                                                                                                                                          • Slide 102
                                                                                                                                                          • Slide 103
                                                                                                                                                          • Slide 104
                                                                                                                                                          • Slide 105
                                                                                                                                                          • Slide 106
                                                                                                                                                          • Slide 107
                                                                                                                                                          • Slide 108
                                                                                                                                                          • Slide 109
                                                                                                                                                          • Slide 110
                                                                                                                                                          • Time Out
                                                                                                                                                          • Token economy
                                                                                                                                                          • Slide 113
                                                                                                                                                          • Slide 114
                                                                                                                                                          • Slide 115
                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                          • Slide 117
                                                                                                                                                          • Slide 118
                                                                                                                                                          • Slide 119
                                                                                                                                                          • Metacognition
                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                          • Slide 124
                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                          • Slide 128
                                                                                                                                                          • Slide 129
                                                                                                                                                          • Broaden and Build
                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                          • Slide 141
                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                          • Slide 146
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                          • Slide 149
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                          • Slide 152
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                          • Slide 154
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                          • Slide 157
                                                                                                                                                          • Slide 158
                                                                                                                                                          • Slide 159
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                          • Slide 162
                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                          • Slide 164
                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                          • Slide 166
                                                                                                                                                          • Slide 167
                                                                                                                                                          • Slide 168
                                                                                                                                                          • Slide 169
                                                                                                                                                          • Slide 170
                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                          • Match the Picture
                                                                                                                                                          • Slide 176
                                                                                                                                                          • Slide 177
                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                          • Slide 179
                                                                                                                                                          • Slide 180
                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                          • Learning Time
                                                                                                                                                          • Learning Time (2)
                                                                                                                                                          • Learning Time (3)
                                                                                                                                                          • Slide 185
                                                                                                                                                          • Slide 186
                                                                                                                                                          • Learning Time (4)
                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                          • Slide 189
                                                                                                                                                          • Slide 190
                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                          • Slide 194
                                                                                                                                                          • Slide 195
                                                                                                                                                          • Slide 196
                                                                                                                                                          • Slide 197
                                                                                                                                                          • Slide 198
                                                                                                                                                          • Slide 199
                                                                                                                                                          • Slide 200
                                                                                                                                                          • Slide 201
                                                                                                                                                          • Quarterly QI review
                                                                                                                                                          • The post-mortem
                                                                                                                                                          • Slide 204
                                                                                                                                                          • Slide 205
                                                                                                                                                          • Slide 206
                                                                                                                                                          • Slide 207
                                                                                                                                                          • Slide 208
                                                                                                                                                          • Slide 209
                                                                                                                                                          • Slide 210
                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                          • Slide 212
                                                                                                                                                          • Slide 213
                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                          • Slide 215
                                                                                                                                                          • Slide 216
                                                                                                                                                          • Slide 217
                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                          • A challengehellip
                                                                                                                                                          • Slide 222

                                                                                                                                                            R P

                                                                                                                                                            +

                                                                                                                                                            -

                                                                                                                                                            R+ P+

                                                                                                                                                            R- P-

                                                                                                                                                            Time Out

                                                                                                                                                            Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                            Token economy

                                                                                                                                                            Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                            Intrinsic motivation

                                                                                                                                                            A B C

                                                                                                                                                            consequencesX

                                                                                                                                                            A B C

                                                                                                                                                            behavior

                                                                                                                                                            Metacognition

                                                                                                                                                            Metacognitive knowledge Metacognitive strategies

                                                                                                                                                            ldquoLend Me Your Brainrdquo

                                                                                                                                                            What Does Dopamine Feel Like

                                                                                                                                                            The Physiology of Motivation and Reward

                                                                                                                                                            Preferred States What Does Dopamine Feel Like

                                                                                                                                                            1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                            David D Nowell PhD189 May Street

                                                                                                                                                            Worcester Mass 01602DrNowellcom

                                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                                            wwwLulucom

                                                                                                                                                            Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                            of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                            clusters groupings There will probably be 4 or 5

                                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                                            Find a word a label for each of the groupings

                                                                                                                                                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                            ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                                            Broaden and Build

                                                                                                                                                            ldquoNeuroMalleabilityrdquo

                                                                                                                                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                            The reward-and-planning system

                                                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                            The reward-and-planning system

                                                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                            Lend Me Your Brain

                                                                                                                                                            Supporting Clients with Executive Dysfunction

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                            Too busy with current activity

                                                                                                                                                            Field dependent

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Sequence problem-solve

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Block out distractions

                                                                                                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                            - E Goldberg

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Get the reward

                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                            Instant gratification vs

                                                                                                                                                            executive gratification

                                                                                                                                                            A B C

                                                                                                                                                            behaviorx

                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                            takerdquordquo

                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                            thathelliprdquo

                                                                                                                                                            Match the Picture

                                                                                                                                                            Distraction Delay Training

                                                                                                                                                            Executive Estimates Training

                                                                                                                                                            X

                                                                                                                                                            Learning Time

                                                                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                            Learning Time

                                                                                                                                                            Learning Time

                                                                                                                                                            Learning Time

                                                                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                            Asking two questionshellip

                                                                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                            this

                                                                                                                                                            what

                                                                                                                                                            I se

                                                                                                                                                            t out

                                                                                                                                                            to

                                                                                                                                                            do

                                                                                                                                                            bullYesbullYes

                                                                                                                                                            bullNobullYes

                                                                                                                                                            bullYesbullNo

                                                                                                                                                            bullNobullNo

                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                            this

                                                                                                                                                            what

                                                                                                                                                            I se

                                                                                                                                                            t out

                                                                                                                                                            to

                                                                                                                                                            do

                                                                                                                                                            bullFunbullOn-task

                                                                                                                                                            bullNot funbullOn-task

                                                                                                                                                            bullFunbullNot on-task

                                                                                                                                                            bullNot funbullNot on-task

                                                                                                                                                            Key Features of Video Games

                                                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                                                            Key Features of Video Games

                                                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                            Volkow et al 2004

                                                                                                                                                            Increase salience

                                                                                                                                                            Increase salience

                                                                                                                                                            Quarterly QI review

                                                                                                                                                            The post-mortem

                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                            Yoga read

                                                                                                                                                            Staff meeting

                                                                                                                                                            Planningsession

                                                                                                                                                            Phone calls

                                                                                                                                                            billing

                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                            Learn French

                                                                                                                                                            Stop smoking

                                                                                                                                                            Be a better spouse

                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                            DavidNowell

                                                                                                                                                            • Slide 1
                                                                                                                                                            • hellipa challenge
                                                                                                                                                            • Slide 3
                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                            • Slide 7
                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                            • Overview
                                                                                                                                                            • This Dense Pudding
                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                            • Slide 12
                                                                                                                                                            • Slide 13
                                                                                                                                                            • Developmental considerations
                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                            • Slide 17
                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                            • Slide 19
                                                                                                                                                            • Strategies
                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                            • Slide 22
                                                                                                                                                            • Slide 23
                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                            • Slide 25
                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                            • Slide 27
                                                                                                                                                            • Slide 28
                                                                                                                                                            • Slide 29
                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                            • Slide 35
                                                                                                                                                            • Strategies (2)
                                                                                                                                                            • (C)APD
                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                            • Self-assessment
                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                            • Slide 42
                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                            • Core symptoms
                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                            • Slide 49
                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                            • Slide 53
                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                            • Slide 63
                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                            • ADHD and girls
                                                                                                                                                            • Slide 66
                                                                                                                                                            • Slide 67
                                                                                                                                                            • ADHD and women
                                                                                                                                                            • Slide 69
                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                            • The Executive Functions
                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                            • Slide 74
                                                                                                                                                            • Slide 75
                                                                                                                                                            • Appropriate expectations
                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                            • Slide 84
                                                                                                                                                            • Slide 85
                                                                                                                                                            • Strategies (3)
                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                            • Behavioral Supports
                                                                                                                                                            • Slide 89
                                                                                                                                                            • Slide 90
                                                                                                                                                            • Slide 91
                                                                                                                                                            • Slide 92
                                                                                                                                                            • Slide 93
                                                                                                                                                            • Slide 94
                                                                                                                                                            • Slide 95
                                                                                                                                                            • Slide 96
                                                                                                                                                            • Slide 97
                                                                                                                                                            • Slide 98
                                                                                                                                                            • Slide 99
                                                                                                                                                            • Slide 100
                                                                                                                                                            • Slide 101
                                                                                                                                                            • Slide 102
                                                                                                                                                            • Slide 103
                                                                                                                                                            • Slide 104
                                                                                                                                                            • Slide 105
                                                                                                                                                            • Slide 106
                                                                                                                                                            • Slide 107
                                                                                                                                                            • Slide 108
                                                                                                                                                            • Slide 109
                                                                                                                                                            • Slide 110
                                                                                                                                                            • Time Out
                                                                                                                                                            • Token economy
                                                                                                                                                            • Slide 113
                                                                                                                                                            • Slide 114
                                                                                                                                                            • Slide 115
                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                            • Slide 117
                                                                                                                                                            • Slide 118
                                                                                                                                                            • Slide 119
                                                                                                                                                            • Metacognition
                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                            • Slide 124
                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                            • Slide 128
                                                                                                                                                            • Slide 129
                                                                                                                                                            • Broaden and Build
                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                            • Slide 141
                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                            • Slide 146
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                            • Slide 149
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                            • Slide 152
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                            • Slide 154
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                            • Slide 157
                                                                                                                                                            • Slide 158
                                                                                                                                                            • Slide 159
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                            • Slide 162
                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                            • Slide 164
                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                            • Slide 166
                                                                                                                                                            • Slide 167
                                                                                                                                                            • Slide 168
                                                                                                                                                            • Slide 169
                                                                                                                                                            • Slide 170
                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                            • Match the Picture
                                                                                                                                                            • Slide 176
                                                                                                                                                            • Slide 177
                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                            • Slide 179
                                                                                                                                                            • Slide 180
                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                            • Learning Time
                                                                                                                                                            • Learning Time (2)
                                                                                                                                                            • Learning Time (3)
                                                                                                                                                            • Slide 185
                                                                                                                                                            • Slide 186
                                                                                                                                                            • Learning Time (4)
                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                            • Slide 189
                                                                                                                                                            • Slide 190
                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                            • Slide 194
                                                                                                                                                            • Slide 195
                                                                                                                                                            • Slide 196
                                                                                                                                                            • Slide 197
                                                                                                                                                            • Slide 198
                                                                                                                                                            • Slide 199
                                                                                                                                                            • Slide 200
                                                                                                                                                            • Slide 201
                                                                                                                                                            • Quarterly QI review
                                                                                                                                                            • The post-mortem
                                                                                                                                                            • Slide 204
                                                                                                                                                            • Slide 205
                                                                                                                                                            • Slide 206
                                                                                                                                                            • Slide 207
                                                                                                                                                            • Slide 208
                                                                                                                                                            • Slide 209
                                                                                                                                                            • Slide 210
                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                            • Slide 212
                                                                                                                                                            • Slide 213
                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                            • Slide 215
                                                                                                                                                            • Slide 216
                                                                                                                                                            • Slide 217
                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                            • A challengehellip
                                                                                                                                                            • Slide 222

                                                                                                                                                              +

                                                                                                                                                              -

                                                                                                                                                              R+ P+

                                                                                                                                                              R- P-

                                                                                                                                                              Time Out

                                                                                                                                                              Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                              Token economy

                                                                                                                                                              Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                              Intrinsic motivation

                                                                                                                                                              A B C

                                                                                                                                                              consequencesX

                                                                                                                                                              A B C

                                                                                                                                                              behavior

                                                                                                                                                              Metacognition

                                                                                                                                                              Metacognitive knowledge Metacognitive strategies

                                                                                                                                                              ldquoLend Me Your Brainrdquo

                                                                                                                                                              What Does Dopamine Feel Like

                                                                                                                                                              The Physiology of Motivation and Reward

                                                                                                                                                              Preferred States What Does Dopamine Feel Like

                                                                                                                                                              1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                              David D Nowell PhD189 May Street

                                                                                                                                                              Worcester Mass 01602DrNowellcom

                                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                                              wwwLulucom

                                                                                                                                                              Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                              of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                              clusters groupings There will probably be 4 or 5

                                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                                              Find a word a label for each of the groupings

                                                                                                                                                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                              ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                                              Broaden and Build

                                                                                                                                                              ldquoNeuroMalleabilityrdquo

                                                                                                                                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                              The reward-and-planning system

                                                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                              The reward-and-planning system

                                                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                              Lend Me Your Brain

                                                                                                                                                              Supporting Clients with Executive Dysfunction

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                              Too busy with current activity

                                                                                                                                                              Field dependent

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Sequence problem-solve

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Block out distractions

                                                                                                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                              - E Goldberg

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Get the reward

                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                              Instant gratification vs

                                                                                                                                                              executive gratification

                                                                                                                                                              A B C

                                                                                                                                                              behaviorx

                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                              takerdquordquo

                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                              thathelliprdquo

                                                                                                                                                              Match the Picture

                                                                                                                                                              Distraction Delay Training

                                                                                                                                                              Executive Estimates Training

                                                                                                                                                              X

                                                                                                                                                              Learning Time

                                                                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                              Learning Time

                                                                                                                                                              Learning Time

                                                                                                                                                              Learning Time

                                                                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                              Asking two questionshellip

                                                                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                              this

                                                                                                                                                              what

                                                                                                                                                              I se

                                                                                                                                                              t out

                                                                                                                                                              to

                                                                                                                                                              do

                                                                                                                                                              bullYesbullYes

                                                                                                                                                              bullNobullYes

                                                                                                                                                              bullYesbullNo

                                                                                                                                                              bullNobullNo

                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                              this

                                                                                                                                                              what

                                                                                                                                                              I se

                                                                                                                                                              t out

                                                                                                                                                              to

                                                                                                                                                              do

                                                                                                                                                              bullFunbullOn-task

                                                                                                                                                              bullNot funbullOn-task

                                                                                                                                                              bullFunbullNot on-task

                                                                                                                                                              bullNot funbullNot on-task

                                                                                                                                                              Key Features of Video Games

                                                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                                                              Key Features of Video Games

                                                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                              Volkow et al 2004

                                                                                                                                                              Increase salience

                                                                                                                                                              Increase salience

                                                                                                                                                              Quarterly QI review

                                                                                                                                                              The post-mortem

                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                              Yoga read

                                                                                                                                                              Staff meeting

                                                                                                                                                              Planningsession

                                                                                                                                                              Phone calls

                                                                                                                                                              billing

                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                              Learn French

                                                                                                                                                              Stop smoking

                                                                                                                                                              Be a better spouse

                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                              DavidNowell

                                                                                                                                                              • Slide 1
                                                                                                                                                              • hellipa challenge
                                                                                                                                                              • Slide 3
                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                              • Slide 7
                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                              • Overview
                                                                                                                                                              • This Dense Pudding
                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                              • Slide 12
                                                                                                                                                              • Slide 13
                                                                                                                                                              • Developmental considerations
                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                              • Slide 17
                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                              • Slide 19
                                                                                                                                                              • Strategies
                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                              • Slide 22
                                                                                                                                                              • Slide 23
                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                              • Slide 25
                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                              • Slide 27
                                                                                                                                                              • Slide 28
                                                                                                                                                              • Slide 29
                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                              • Slide 35
                                                                                                                                                              • Strategies (2)
                                                                                                                                                              • (C)APD
                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                              • Self-assessment
                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                              • Slide 42
                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                              • Core symptoms
                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                              • Slide 49
                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                              • Slide 53
                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                              • Slide 63
                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                              • ADHD and girls
                                                                                                                                                              • Slide 66
                                                                                                                                                              • Slide 67
                                                                                                                                                              • ADHD and women
                                                                                                                                                              • Slide 69
                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                              • The Executive Functions
                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                              • Slide 74
                                                                                                                                                              • Slide 75
                                                                                                                                                              • Appropriate expectations
                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                              • Slide 84
                                                                                                                                                              • Slide 85
                                                                                                                                                              • Strategies (3)
                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                              • Behavioral Supports
                                                                                                                                                              • Slide 89
                                                                                                                                                              • Slide 90
                                                                                                                                                              • Slide 91
                                                                                                                                                              • Slide 92
                                                                                                                                                              • Slide 93
                                                                                                                                                              • Slide 94
                                                                                                                                                              • Slide 95
                                                                                                                                                              • Slide 96
                                                                                                                                                              • Slide 97
                                                                                                                                                              • Slide 98
                                                                                                                                                              • Slide 99
                                                                                                                                                              • Slide 100
                                                                                                                                                              • Slide 101
                                                                                                                                                              • Slide 102
                                                                                                                                                              • Slide 103
                                                                                                                                                              • Slide 104
                                                                                                                                                              • Slide 105
                                                                                                                                                              • Slide 106
                                                                                                                                                              • Slide 107
                                                                                                                                                              • Slide 108
                                                                                                                                                              • Slide 109
                                                                                                                                                              • Slide 110
                                                                                                                                                              • Time Out
                                                                                                                                                              • Token economy
                                                                                                                                                              • Slide 113
                                                                                                                                                              • Slide 114
                                                                                                                                                              • Slide 115
                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                              • Slide 117
                                                                                                                                                              • Slide 118
                                                                                                                                                              • Slide 119
                                                                                                                                                              • Metacognition
                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                              • Slide 124
                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                              • Slide 128
                                                                                                                                                              • Slide 129
                                                                                                                                                              • Broaden and Build
                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                              • Slide 141
                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                              • Slide 146
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                              • Slide 149
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                              • Slide 152
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                              • Slide 154
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                              • Slide 157
                                                                                                                                                              • Slide 158
                                                                                                                                                              • Slide 159
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                              • Slide 162
                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                              • Slide 164
                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                              • Slide 166
                                                                                                                                                              • Slide 167
                                                                                                                                                              • Slide 168
                                                                                                                                                              • Slide 169
                                                                                                                                                              • Slide 170
                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                              • Match the Picture
                                                                                                                                                              • Slide 176
                                                                                                                                                              • Slide 177
                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                              • Slide 179
                                                                                                                                                              • Slide 180
                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                              • Learning Time
                                                                                                                                                              • Learning Time (2)
                                                                                                                                                              • Learning Time (3)
                                                                                                                                                              • Slide 185
                                                                                                                                                              • Slide 186
                                                                                                                                                              • Learning Time (4)
                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                              • Slide 189
                                                                                                                                                              • Slide 190
                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                              • Slide 194
                                                                                                                                                              • Slide 195
                                                                                                                                                              • Slide 196
                                                                                                                                                              • Slide 197
                                                                                                                                                              • Slide 198
                                                                                                                                                              • Slide 199
                                                                                                                                                              • Slide 200
                                                                                                                                                              • Slide 201
                                                                                                                                                              • Quarterly QI review
                                                                                                                                                              • The post-mortem
                                                                                                                                                              • Slide 204
                                                                                                                                                              • Slide 205
                                                                                                                                                              • Slide 206
                                                                                                                                                              • Slide 207
                                                                                                                                                              • Slide 208
                                                                                                                                                              • Slide 209
                                                                                                                                                              • Slide 210
                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                              • Slide 212
                                                                                                                                                              • Slide 213
                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                              • Slide 215
                                                                                                                                                              • Slide 216
                                                                                                                                                              • Slide 217
                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                              • A challengehellip
                                                                                                                                                              • Slide 222

                                                                                                                                                                R+ P+

                                                                                                                                                                R- P-

                                                                                                                                                                Time Out

                                                                                                                                                                Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                                Token economy

                                                                                                                                                                Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                                Intrinsic motivation

                                                                                                                                                                A B C

                                                                                                                                                                consequencesX

                                                                                                                                                                A B C

                                                                                                                                                                behavior

                                                                                                                                                                Metacognition

                                                                                                                                                                Metacognitive knowledge Metacognitive strategies

                                                                                                                                                                ldquoLend Me Your Brainrdquo

                                                                                                                                                                What Does Dopamine Feel Like

                                                                                                                                                                The Physiology of Motivation and Reward

                                                                                                                                                                Preferred States What Does Dopamine Feel Like

                                                                                                                                                                1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                David D Nowell PhD189 May Street

                                                                                                                                                                Worcester Mass 01602DrNowellcom

                                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                                wwwLulucom

                                                                                                                                                                Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                clusters groupings There will probably be 4 or 5

                                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                                Find a word a label for each of the groupings

                                                                                                                                                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                                Broaden and Build

                                                                                                                                                                ldquoNeuroMalleabilityrdquo

                                                                                                                                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                The reward-and-planning system

                                                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                The reward-and-planning system

                                                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                Lend Me Your Brain

                                                                                                                                                                Supporting Clients with Executive Dysfunction

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                Too busy with current activity

                                                                                                                                                                Field dependent

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Sequence problem-solve

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Block out distractions

                                                                                                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                - E Goldberg

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Get the reward

                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                Instant gratification vs

                                                                                                                                                                executive gratification

                                                                                                                                                                A B C

                                                                                                                                                                behaviorx

                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                takerdquordquo

                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                thathelliprdquo

                                                                                                                                                                Match the Picture

                                                                                                                                                                Distraction Delay Training

                                                                                                                                                                Executive Estimates Training

                                                                                                                                                                X

                                                                                                                                                                Learning Time

                                                                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                Learning Time

                                                                                                                                                                Learning Time

                                                                                                                                                                Learning Time

                                                                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                Asking two questionshellip

                                                                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                this

                                                                                                                                                                what

                                                                                                                                                                I se

                                                                                                                                                                t out

                                                                                                                                                                to

                                                                                                                                                                do

                                                                                                                                                                bullYesbullYes

                                                                                                                                                                bullNobullYes

                                                                                                                                                                bullYesbullNo

                                                                                                                                                                bullNobullNo

                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                this

                                                                                                                                                                what

                                                                                                                                                                I se

                                                                                                                                                                t out

                                                                                                                                                                to

                                                                                                                                                                do

                                                                                                                                                                bullFunbullOn-task

                                                                                                                                                                bullNot funbullOn-task

                                                                                                                                                                bullFunbullNot on-task

                                                                                                                                                                bullNot funbullNot on-task

                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                Volkow et al 2004

                                                                                                                                                                Increase salience

                                                                                                                                                                Increase salience

                                                                                                                                                                Quarterly QI review

                                                                                                                                                                The post-mortem

                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                Yoga read

                                                                                                                                                                Staff meeting

                                                                                                                                                                Planningsession

                                                                                                                                                                Phone calls

                                                                                                                                                                billing

                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                Learn French

                                                                                                                                                                Stop smoking

                                                                                                                                                                Be a better spouse

                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                DavidNowell

                                                                                                                                                                • Slide 1
                                                                                                                                                                • hellipa challenge
                                                                                                                                                                • Slide 3
                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                • Slide 7
                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                • Overview
                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                • Slide 12
                                                                                                                                                                • Slide 13
                                                                                                                                                                • Developmental considerations
                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                • Slide 17
                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                • Slide 19
                                                                                                                                                                • Strategies
                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                • Slide 22
                                                                                                                                                                • Slide 23
                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                • Slide 25
                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                • Slide 27
                                                                                                                                                                • Slide 28
                                                                                                                                                                • Slide 29
                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                • Slide 35
                                                                                                                                                                • Strategies (2)
                                                                                                                                                                • (C)APD
                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                • Self-assessment
                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                • Slide 42
                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                • Core symptoms
                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                • Slide 49
                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                • Slide 53
                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                • Slide 63
                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                • ADHD and girls
                                                                                                                                                                • Slide 66
                                                                                                                                                                • Slide 67
                                                                                                                                                                • ADHD and women
                                                                                                                                                                • Slide 69
                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                • The Executive Functions
                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                • Slide 74
                                                                                                                                                                • Slide 75
                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                • Slide 84
                                                                                                                                                                • Slide 85
                                                                                                                                                                • Strategies (3)
                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                • Slide 89
                                                                                                                                                                • Slide 90
                                                                                                                                                                • Slide 91
                                                                                                                                                                • Slide 92
                                                                                                                                                                • Slide 93
                                                                                                                                                                • Slide 94
                                                                                                                                                                • Slide 95
                                                                                                                                                                • Slide 96
                                                                                                                                                                • Slide 97
                                                                                                                                                                • Slide 98
                                                                                                                                                                • Slide 99
                                                                                                                                                                • Slide 100
                                                                                                                                                                • Slide 101
                                                                                                                                                                • Slide 102
                                                                                                                                                                • Slide 103
                                                                                                                                                                • Slide 104
                                                                                                                                                                • Slide 105
                                                                                                                                                                • Slide 106
                                                                                                                                                                • Slide 107
                                                                                                                                                                • Slide 108
                                                                                                                                                                • Slide 109
                                                                                                                                                                • Slide 110
                                                                                                                                                                • Time Out
                                                                                                                                                                • Token economy
                                                                                                                                                                • Slide 113
                                                                                                                                                                • Slide 114
                                                                                                                                                                • Slide 115
                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                • Slide 117
                                                                                                                                                                • Slide 118
                                                                                                                                                                • Slide 119
                                                                                                                                                                • Metacognition
                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                • Slide 124
                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                • Slide 128
                                                                                                                                                                • Slide 129
                                                                                                                                                                • Broaden and Build
                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                • Slide 141
                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                • Slide 146
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                • Slide 149
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                • Slide 152
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                • Slide 154
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                • Slide 157
                                                                                                                                                                • Slide 158
                                                                                                                                                                • Slide 159
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                • Slide 162
                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                • Slide 164
                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                • Slide 166
                                                                                                                                                                • Slide 167
                                                                                                                                                                • Slide 168
                                                                                                                                                                • Slide 169
                                                                                                                                                                • Slide 170
                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                • Match the Picture
                                                                                                                                                                • Slide 176
                                                                                                                                                                • Slide 177
                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                • Slide 179
                                                                                                                                                                • Slide 180
                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                • Learning Time
                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                • Slide 185
                                                                                                                                                                • Slide 186
                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                • Slide 189
                                                                                                                                                                • Slide 190
                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                • Slide 194
                                                                                                                                                                • Slide 195
                                                                                                                                                                • Slide 196
                                                                                                                                                                • Slide 197
                                                                                                                                                                • Slide 198
                                                                                                                                                                • Slide 199
                                                                                                                                                                • Slide 200
                                                                                                                                                                • Slide 201
                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                • The post-mortem
                                                                                                                                                                • Slide 204
                                                                                                                                                                • Slide 205
                                                                                                                                                                • Slide 206
                                                                                                                                                                • Slide 207
                                                                                                                                                                • Slide 208
                                                                                                                                                                • Slide 209
                                                                                                                                                                • Slide 210
                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                • Slide 212
                                                                                                                                                                • Slide 213
                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                • Slide 215
                                                                                                                                                                • Slide 216
                                                                                                                                                                • Slide 217
                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                • A challengehellip
                                                                                                                                                                • Slide 222

                                                                                                                                                                  Time Out

                                                                                                                                                                  Select target behavior Set place Determine how much time Dress rehearsal Measure the time Withdraw attention Establish the cause and effect

                                                                                                                                                                  Token economy

                                                                                                                                                                  Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                                  Intrinsic motivation

                                                                                                                                                                  A B C

                                                                                                                                                                  consequencesX

                                                                                                                                                                  A B C

                                                                                                                                                                  behavior

                                                                                                                                                                  Metacognition

                                                                                                                                                                  Metacognitive knowledge Metacognitive strategies

                                                                                                                                                                  ldquoLend Me Your Brainrdquo

                                                                                                                                                                  What Does Dopamine Feel Like

                                                                                                                                                                  The Physiology of Motivation and Reward

                                                                                                                                                                  Preferred States What Does Dopamine Feel Like

                                                                                                                                                                  1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                  David D Nowell PhD189 May Street

                                                                                                                                                                  Worcester Mass 01602DrNowellcom

                                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                                  wwwLulucom

                                                                                                                                                                  Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                  of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                  clusters groupings There will probably be 4 or 5

                                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                                  Find a word a label for each of the groupings

                                                                                                                                                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                  ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                                  Broaden and Build

                                                                                                                                                                  ldquoNeuroMalleabilityrdquo

                                                                                                                                                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                  The reward-and-planning system

                                                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                  The reward-and-planning system

                                                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                  Lend Me Your Brain

                                                                                                                                                                  Supporting Clients with Executive Dysfunction

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                  Too busy with current activity

                                                                                                                                                                  Field dependent

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Sequence problem-solve

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Block out distractions

                                                                                                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                  - E Goldberg

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Get the reward

                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                  Instant gratification vs

                                                                                                                                                                  executive gratification

                                                                                                                                                                  A B C

                                                                                                                                                                  behaviorx

                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                  takerdquordquo

                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                  thathelliprdquo

                                                                                                                                                                  Match the Picture

                                                                                                                                                                  Distraction Delay Training

                                                                                                                                                                  Executive Estimates Training

                                                                                                                                                                  X

                                                                                                                                                                  Learning Time

                                                                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                  Learning Time

                                                                                                                                                                  Learning Time

                                                                                                                                                                  Learning Time

                                                                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                  Asking two questionshellip

                                                                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                  this

                                                                                                                                                                  what

                                                                                                                                                                  I se

                                                                                                                                                                  t out

                                                                                                                                                                  to

                                                                                                                                                                  do

                                                                                                                                                                  bullYesbullYes

                                                                                                                                                                  bullNobullYes

                                                                                                                                                                  bullYesbullNo

                                                                                                                                                                  bullNobullNo

                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                  this

                                                                                                                                                                  what

                                                                                                                                                                  I se

                                                                                                                                                                  t out

                                                                                                                                                                  to

                                                                                                                                                                  do

                                                                                                                                                                  bullFunbullOn-task

                                                                                                                                                                  bullNot funbullOn-task

                                                                                                                                                                  bullFunbullNot on-task

                                                                                                                                                                  bullNot funbullNot on-task

                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                  Volkow et al 2004

                                                                                                                                                                  Increase salience

                                                                                                                                                                  Increase salience

                                                                                                                                                                  Quarterly QI review

                                                                                                                                                                  The post-mortem

                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                  Yoga read

                                                                                                                                                                  Staff meeting

                                                                                                                                                                  Planningsession

                                                                                                                                                                  Phone calls

                                                                                                                                                                  billing

                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                  Learn French

                                                                                                                                                                  Stop smoking

                                                                                                                                                                  Be a better spouse

                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                  DavidNowell

                                                                                                                                                                  • Slide 1
                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                  • Slide 3
                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                  • Slide 7
                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                  • Overview
                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                  • Slide 12
                                                                                                                                                                  • Slide 13
                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                  • Slide 17
                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                  • Slide 19
                                                                                                                                                                  • Strategies
                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                  • Slide 22
                                                                                                                                                                  • Slide 23
                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                  • Slide 25
                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                  • Slide 27
                                                                                                                                                                  • Slide 28
                                                                                                                                                                  • Slide 29
                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                  • Slide 35
                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                  • (C)APD
                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                  • Self-assessment
                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                  • Slide 42
                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                  • Core symptoms
                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                  • Slide 49
                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                  • Slide 53
                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                  • Slide 63
                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                  • Slide 66
                                                                                                                                                                  • Slide 67
                                                                                                                                                                  • ADHD and women
                                                                                                                                                                  • Slide 69
                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                  • Slide 74
                                                                                                                                                                  • Slide 75
                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                  • Slide 84
                                                                                                                                                                  • Slide 85
                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                  • Slide 89
                                                                                                                                                                  • Slide 90
                                                                                                                                                                  • Slide 91
                                                                                                                                                                  • Slide 92
                                                                                                                                                                  • Slide 93
                                                                                                                                                                  • Slide 94
                                                                                                                                                                  • Slide 95
                                                                                                                                                                  • Slide 96
                                                                                                                                                                  • Slide 97
                                                                                                                                                                  • Slide 98
                                                                                                                                                                  • Slide 99
                                                                                                                                                                  • Slide 100
                                                                                                                                                                  • Slide 101
                                                                                                                                                                  • Slide 102
                                                                                                                                                                  • Slide 103
                                                                                                                                                                  • Slide 104
                                                                                                                                                                  • Slide 105
                                                                                                                                                                  • Slide 106
                                                                                                                                                                  • Slide 107
                                                                                                                                                                  • Slide 108
                                                                                                                                                                  • Slide 109
                                                                                                                                                                  • Slide 110
                                                                                                                                                                  • Time Out
                                                                                                                                                                  • Token economy
                                                                                                                                                                  • Slide 113
                                                                                                                                                                  • Slide 114
                                                                                                                                                                  • Slide 115
                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                  • Slide 117
                                                                                                                                                                  • Slide 118
                                                                                                                                                                  • Slide 119
                                                                                                                                                                  • Metacognition
                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                  • Slide 124
                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                  • Slide 128
                                                                                                                                                                  • Slide 129
                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                  • Slide 141
                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                  • Slide 146
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                  • Slide 149
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                  • Slide 152
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                  • Slide 154
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                  • Slide 157
                                                                                                                                                                  • Slide 158
                                                                                                                                                                  • Slide 159
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                  • Slide 162
                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                  • Slide 164
                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                  • Slide 166
                                                                                                                                                                  • Slide 167
                                                                                                                                                                  • Slide 168
                                                                                                                                                                  • Slide 169
                                                                                                                                                                  • Slide 170
                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                  • Match the Picture
                                                                                                                                                                  • Slide 176
                                                                                                                                                                  • Slide 177
                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                  • Slide 179
                                                                                                                                                                  • Slide 180
                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                  • Learning Time
                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                  • Slide 185
                                                                                                                                                                  • Slide 186
                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                  • Slide 189
                                                                                                                                                                  • Slide 190
                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                  • Slide 194
                                                                                                                                                                  • Slide 195
                                                                                                                                                                  • Slide 196
                                                                                                                                                                  • Slide 197
                                                                                                                                                                  • Slide 198
                                                                                                                                                                  • Slide 199
                                                                                                                                                                  • Slide 200
                                                                                                                                                                  • Slide 201
                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                  • The post-mortem
                                                                                                                                                                  • Slide 204
                                                                                                                                                                  • Slide 205
                                                                                                                                                                  • Slide 206
                                                                                                                                                                  • Slide 207
                                                                                                                                                                  • Slide 208
                                                                                                                                                                  • Slide 209
                                                                                                                                                                  • Slide 210
                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                  • Slide 212
                                                                                                                                                                  • Slide 213
                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                  • Slide 215
                                                                                                                                                                  • Slide 216
                                                                                                                                                                  • Slide 217
                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                  • A challengehellip
                                                                                                                                                                  • Slide 222

                                                                                                                                                                    Token economy

                                                                                                                                                                    Good balance Precursor to adult reinforcement system Lots of work to do well Even more work to set up well

                                                                                                                                                                    Intrinsic motivation

                                                                                                                                                                    A B C

                                                                                                                                                                    consequencesX

                                                                                                                                                                    A B C

                                                                                                                                                                    behavior

                                                                                                                                                                    Metacognition

                                                                                                                                                                    Metacognitive knowledge Metacognitive strategies

                                                                                                                                                                    ldquoLend Me Your Brainrdquo

                                                                                                                                                                    What Does Dopamine Feel Like

                                                                                                                                                                    The Physiology of Motivation and Reward

                                                                                                                                                                    Preferred States What Does Dopamine Feel Like

                                                                                                                                                                    1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                    David D Nowell PhD189 May Street

                                                                                                                                                                    Worcester Mass 01602DrNowellcom

                                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                                    wwwLulucom

                                                                                                                                                                    Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                    of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                    clusters groupings There will probably be 4 or 5

                                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                                    Find a word a label for each of the groupings

                                                                                                                                                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                    ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                                    Broaden and Build

                                                                                                                                                                    ldquoNeuroMalleabilityrdquo

                                                                                                                                                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                    The reward-and-planning system

                                                                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                    The reward-and-planning system

                                                                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                    Lend Me Your Brain

                                                                                                                                                                    Supporting Clients with Executive Dysfunction

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                    Too busy with current activity

                                                                                                                                                                    Field dependent

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Sequence problem-solve

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Block out distractions

                                                                                                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                    - E Goldberg

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Get the reward

                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                    Instant gratification vs

                                                                                                                                                                    executive gratification

                                                                                                                                                                    A B C

                                                                                                                                                                    behaviorx

                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                    takerdquordquo

                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                    thathelliprdquo

                                                                                                                                                                    Match the Picture

                                                                                                                                                                    Distraction Delay Training

                                                                                                                                                                    Executive Estimates Training

                                                                                                                                                                    X

                                                                                                                                                                    Learning Time

                                                                                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                    Learning Time

                                                                                                                                                                    Learning Time

                                                                                                                                                                    Learning Time

                                                                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                    Asking two questionshellip

                                                                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                    this

                                                                                                                                                                    what

                                                                                                                                                                    I se

                                                                                                                                                                    t out

                                                                                                                                                                    to

                                                                                                                                                                    do

                                                                                                                                                                    bullYesbullYes

                                                                                                                                                                    bullNobullYes

                                                                                                                                                                    bullYesbullNo

                                                                                                                                                                    bullNobullNo

                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                    this

                                                                                                                                                                    what

                                                                                                                                                                    I se

                                                                                                                                                                    t out

                                                                                                                                                                    to

                                                                                                                                                                    do

                                                                                                                                                                    bullFunbullOn-task

                                                                                                                                                                    bullNot funbullOn-task

                                                                                                                                                                    bullFunbullNot on-task

                                                                                                                                                                    bullNot funbullNot on-task

                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                    Volkow et al 2004

                                                                                                                                                                    Increase salience

                                                                                                                                                                    Increase salience

                                                                                                                                                                    Quarterly QI review

                                                                                                                                                                    The post-mortem

                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                    Yoga read

                                                                                                                                                                    Staff meeting

                                                                                                                                                                    Planningsession

                                                                                                                                                                    Phone calls

                                                                                                                                                                    billing

                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                    Learn French

                                                                                                                                                                    Stop smoking

                                                                                                                                                                    Be a better spouse

                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                    DavidNowell

                                                                                                                                                                    • Slide 1
                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                    • Slide 3
                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                    • Slide 7
                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                    • Overview
                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                    • Slide 12
                                                                                                                                                                    • Slide 13
                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                    • Slide 17
                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                    • Slide 19
                                                                                                                                                                    • Strategies
                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                    • Slide 22
                                                                                                                                                                    • Slide 23
                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                    • Slide 25
                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                    • Slide 27
                                                                                                                                                                    • Slide 28
                                                                                                                                                                    • Slide 29
                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                    • Slide 35
                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                    • (C)APD
                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                    • Self-assessment
                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                    • Slide 42
                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                    • Core symptoms
                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                    • Slide 49
                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                    • Slide 53
                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                    • Slide 63
                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                    • Slide 66
                                                                                                                                                                    • Slide 67
                                                                                                                                                                    • ADHD and women
                                                                                                                                                                    • Slide 69
                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                    • Slide 74
                                                                                                                                                                    • Slide 75
                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                    • Slide 84
                                                                                                                                                                    • Slide 85
                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                    • Slide 89
                                                                                                                                                                    • Slide 90
                                                                                                                                                                    • Slide 91
                                                                                                                                                                    • Slide 92
                                                                                                                                                                    • Slide 93
                                                                                                                                                                    • Slide 94
                                                                                                                                                                    • Slide 95
                                                                                                                                                                    • Slide 96
                                                                                                                                                                    • Slide 97
                                                                                                                                                                    • Slide 98
                                                                                                                                                                    • Slide 99
                                                                                                                                                                    • Slide 100
                                                                                                                                                                    • Slide 101
                                                                                                                                                                    • Slide 102
                                                                                                                                                                    • Slide 103
                                                                                                                                                                    • Slide 104
                                                                                                                                                                    • Slide 105
                                                                                                                                                                    • Slide 106
                                                                                                                                                                    • Slide 107
                                                                                                                                                                    • Slide 108
                                                                                                                                                                    • Slide 109
                                                                                                                                                                    • Slide 110
                                                                                                                                                                    • Time Out
                                                                                                                                                                    • Token economy
                                                                                                                                                                    • Slide 113
                                                                                                                                                                    • Slide 114
                                                                                                                                                                    • Slide 115
                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                    • Slide 117
                                                                                                                                                                    • Slide 118
                                                                                                                                                                    • Slide 119
                                                                                                                                                                    • Metacognition
                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                    • Slide 124
                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                    • Slide 128
                                                                                                                                                                    • Slide 129
                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                    • Slide 141
                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                    • Slide 146
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                    • Slide 149
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                    • Slide 152
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                    • Slide 154
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                    • Slide 157
                                                                                                                                                                    • Slide 158
                                                                                                                                                                    • Slide 159
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                    • Slide 162
                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                    • Slide 164
                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                    • Slide 166
                                                                                                                                                                    • Slide 167
                                                                                                                                                                    • Slide 168
                                                                                                                                                                    • Slide 169
                                                                                                                                                                    • Slide 170
                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                    • Match the Picture
                                                                                                                                                                    • Slide 176
                                                                                                                                                                    • Slide 177
                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                    • Slide 179
                                                                                                                                                                    • Slide 180
                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                    • Learning Time
                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                    • Slide 185
                                                                                                                                                                    • Slide 186
                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                    • Slide 189
                                                                                                                                                                    • Slide 190
                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                    • Slide 194
                                                                                                                                                                    • Slide 195
                                                                                                                                                                    • Slide 196
                                                                                                                                                                    • Slide 197
                                                                                                                                                                    • Slide 198
                                                                                                                                                                    • Slide 199
                                                                                                                                                                    • Slide 200
                                                                                                                                                                    • Slide 201
                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                    • The post-mortem
                                                                                                                                                                    • Slide 204
                                                                                                                                                                    • Slide 205
                                                                                                                                                                    • Slide 206
                                                                                                                                                                    • Slide 207
                                                                                                                                                                    • Slide 208
                                                                                                                                                                    • Slide 209
                                                                                                                                                                    • Slide 210
                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                    • Slide 212
                                                                                                                                                                    • Slide 213
                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                    • Slide 215
                                                                                                                                                                    • Slide 216
                                                                                                                                                                    • Slide 217
                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                    • A challengehellip
                                                                                                                                                                    • Slide 222

                                                                                                                                                                      Intrinsic motivation

                                                                                                                                                                      A B C

                                                                                                                                                                      consequencesX

                                                                                                                                                                      A B C

                                                                                                                                                                      behavior

                                                                                                                                                                      Metacognition

                                                                                                                                                                      Metacognitive knowledge Metacognitive strategies

                                                                                                                                                                      ldquoLend Me Your Brainrdquo

                                                                                                                                                                      What Does Dopamine Feel Like

                                                                                                                                                                      The Physiology of Motivation and Reward

                                                                                                                                                                      Preferred States What Does Dopamine Feel Like

                                                                                                                                                                      1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                      David D Nowell PhD189 May Street

                                                                                                                                                                      Worcester Mass 01602DrNowellcom

                                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                                      wwwLulucom

                                                                                                                                                                      Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                      of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                      clusters groupings There will probably be 4 or 5

                                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                                      Find a word a label for each of the groupings

                                                                                                                                                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                      ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                                      Broaden and Build

                                                                                                                                                                      ldquoNeuroMalleabilityrdquo

                                                                                                                                                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                      The reward-and-planning system

                                                                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                      The reward-and-planning system

                                                                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                      Lend Me Your Brain

                                                                                                                                                                      Supporting Clients with Executive Dysfunction

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                      Too busy with current activity

                                                                                                                                                                      Field dependent

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Sequence problem-solve

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Block out distractions

                                                                                                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                      - E Goldberg

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Get the reward

                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                      Instant gratification vs

                                                                                                                                                                      executive gratification

                                                                                                                                                                      A B C

                                                                                                                                                                      behaviorx

                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                      takerdquordquo

                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                      thathelliprdquo

                                                                                                                                                                      Match the Picture

                                                                                                                                                                      Distraction Delay Training

                                                                                                                                                                      Executive Estimates Training

                                                                                                                                                                      X

                                                                                                                                                                      Learning Time

                                                                                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                      Learning Time

                                                                                                                                                                      Learning Time

                                                                                                                                                                      Learning Time

                                                                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                      Asking two questionshellip

                                                                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                      this

                                                                                                                                                                      what

                                                                                                                                                                      I se

                                                                                                                                                                      t out

                                                                                                                                                                      to

                                                                                                                                                                      do

                                                                                                                                                                      bullYesbullYes

                                                                                                                                                                      bullNobullYes

                                                                                                                                                                      bullYesbullNo

                                                                                                                                                                      bullNobullNo

                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                      this

                                                                                                                                                                      what

                                                                                                                                                                      I se

                                                                                                                                                                      t out

                                                                                                                                                                      to

                                                                                                                                                                      do

                                                                                                                                                                      bullFunbullOn-task

                                                                                                                                                                      bullNot funbullOn-task

                                                                                                                                                                      bullFunbullNot on-task

                                                                                                                                                                      bullNot funbullNot on-task

                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                      Volkow et al 2004

                                                                                                                                                                      Increase salience

                                                                                                                                                                      Increase salience

                                                                                                                                                                      Quarterly QI review

                                                                                                                                                                      The post-mortem

                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                      Yoga read

                                                                                                                                                                      Staff meeting

                                                                                                                                                                      Planningsession

                                                                                                                                                                      Phone calls

                                                                                                                                                                      billing

                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                      Learn French

                                                                                                                                                                      Stop smoking

                                                                                                                                                                      Be a better spouse

                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                                      DavidNowell

                                                                                                                                                                      • Slide 1
                                                                                                                                                                      • hellipa challenge
                                                                                                                                                                      • Slide 3
                                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                      • Slide 7
                                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                                      • Overview
                                                                                                                                                                      • This Dense Pudding
                                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                                      • Slide 12
                                                                                                                                                                      • Slide 13
                                                                                                                                                                      • Developmental considerations
                                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                      • Slide 17
                                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                      • Slide 19
                                                                                                                                                                      • Strategies
                                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                                      • Slide 22
                                                                                                                                                                      • Slide 23
                                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                      • Slide 25
                                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                                      • Slide 27
                                                                                                                                                                      • Slide 28
                                                                                                                                                                      • Slide 29
                                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                      • Slide 35
                                                                                                                                                                      • Strategies (2)
                                                                                                                                                                      • (C)APD
                                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                                      • Self-assessment
                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                      • Slide 42
                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                      • Core symptoms
                                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                                      • Slide 49
                                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                                      • Slide 53
                                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                                      • Slide 63
                                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                                      • ADHD and girls
                                                                                                                                                                      • Slide 66
                                                                                                                                                                      • Slide 67
                                                                                                                                                                      • ADHD and women
                                                                                                                                                                      • Slide 69
                                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                                      • The Executive Functions
                                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                                      • Slide 74
                                                                                                                                                                      • Slide 75
                                                                                                                                                                      • Appropriate expectations
                                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                      • Slide 84
                                                                                                                                                                      • Slide 85
                                                                                                                                                                      • Strategies (3)
                                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                                      • Behavioral Supports
                                                                                                                                                                      • Slide 89
                                                                                                                                                                      • Slide 90
                                                                                                                                                                      • Slide 91
                                                                                                                                                                      • Slide 92
                                                                                                                                                                      • Slide 93
                                                                                                                                                                      • Slide 94
                                                                                                                                                                      • Slide 95
                                                                                                                                                                      • Slide 96
                                                                                                                                                                      • Slide 97
                                                                                                                                                                      • Slide 98
                                                                                                                                                                      • Slide 99
                                                                                                                                                                      • Slide 100
                                                                                                                                                                      • Slide 101
                                                                                                                                                                      • Slide 102
                                                                                                                                                                      • Slide 103
                                                                                                                                                                      • Slide 104
                                                                                                                                                                      • Slide 105
                                                                                                                                                                      • Slide 106
                                                                                                                                                                      • Slide 107
                                                                                                                                                                      • Slide 108
                                                                                                                                                                      • Slide 109
                                                                                                                                                                      • Slide 110
                                                                                                                                                                      • Time Out
                                                                                                                                                                      • Token economy
                                                                                                                                                                      • Slide 113
                                                                                                                                                                      • Slide 114
                                                                                                                                                                      • Slide 115
                                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                                      • Slide 117
                                                                                                                                                                      • Slide 118
                                                                                                                                                                      • Slide 119
                                                                                                                                                                      • Metacognition
                                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                      • Slide 124
                                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                      • Slide 128
                                                                                                                                                                      • Slide 129
                                                                                                                                                                      • Broaden and Build
                                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                      • Slide 141
                                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                      • Slide 146
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                      • Slide 149
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                      • Slide 152
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                      • Slide 154
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                      • Slide 157
                                                                                                                                                                      • Slide 158
                                                                                                                                                                      • Slide 159
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                      • Slide 162
                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                      • Slide 164
                                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                                      • Slide 166
                                                                                                                                                                      • Slide 167
                                                                                                                                                                      • Slide 168
                                                                                                                                                                      • Slide 169
                                                                                                                                                                      • Slide 170
                                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                                      • Match the Picture
                                                                                                                                                                      • Slide 176
                                                                                                                                                                      • Slide 177
                                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                                      • Slide 179
                                                                                                                                                                      • Slide 180
                                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                                      • Learning Time
                                                                                                                                                                      • Learning Time (2)
                                                                                                                                                                      • Learning Time (3)
                                                                                                                                                                      • Slide 185
                                                                                                                                                                      • Slide 186
                                                                                                                                                                      • Learning Time (4)
                                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                                      • Slide 189
                                                                                                                                                                      • Slide 190
                                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                      • Slide 194
                                                                                                                                                                      • Slide 195
                                                                                                                                                                      • Slide 196
                                                                                                                                                                      • Slide 197
                                                                                                                                                                      • Slide 198
                                                                                                                                                                      • Slide 199
                                                                                                                                                                      • Slide 200
                                                                                                                                                                      • Slide 201
                                                                                                                                                                      • Quarterly QI review
                                                                                                                                                                      • The post-mortem
                                                                                                                                                                      • Slide 204
                                                                                                                                                                      • Slide 205
                                                                                                                                                                      • Slide 206
                                                                                                                                                                      • Slide 207
                                                                                                                                                                      • Slide 208
                                                                                                                                                                      • Slide 209
                                                                                                                                                                      • Slide 210
                                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                                      • Slide 212
                                                                                                                                                                      • Slide 213
                                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                                      • Slide 215
                                                                                                                                                                      • Slide 216
                                                                                                                                                                      • Slide 217
                                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                                      • A challengehellip
                                                                                                                                                                      • Slide 222

                                                                                                                                                                        A B C

                                                                                                                                                                        consequencesX

                                                                                                                                                                        A B C

                                                                                                                                                                        behavior

                                                                                                                                                                        Metacognition

                                                                                                                                                                        Metacognitive knowledge Metacognitive strategies

                                                                                                                                                                        ldquoLend Me Your Brainrdquo

                                                                                                                                                                        What Does Dopamine Feel Like

                                                                                                                                                                        The Physiology of Motivation and Reward

                                                                                                                                                                        Preferred States What Does Dopamine Feel Like

                                                                                                                                                                        1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                        David D Nowell PhD189 May Street

                                                                                                                                                                        Worcester Mass 01602DrNowellcom

                                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                                        wwwLulucom

                                                                                                                                                                        Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                        highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                        of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                        clusters groupings There will probably be 4 or 5

                                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                                        Find a word a label for each of the groupings

                                                                                                                                                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                        ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                                        Broaden and Build

                                                                                                                                                                        ldquoNeuroMalleabilityrdquo

                                                                                                                                                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                        The reward-and-planning system

                                                                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                        The reward-and-planning system

                                                                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                        Lend Me Your Brain

                                                                                                                                                                        Supporting Clients with Executive Dysfunction

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                        Too busy with current activity

                                                                                                                                                                        Field dependent

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Sequence problem-solve

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Block out distractions

                                                                                                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                        - E Goldberg

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Get the reward

                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                        Instant gratification vs

                                                                                                                                                                        executive gratification

                                                                                                                                                                        A B C

                                                                                                                                                                        behaviorx

                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                        takerdquordquo

                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                        thathelliprdquo

                                                                                                                                                                        Match the Picture

                                                                                                                                                                        Distraction Delay Training

                                                                                                                                                                        Executive Estimates Training

                                                                                                                                                                        X

                                                                                                                                                                        Learning Time

                                                                                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                        Learning Time

                                                                                                                                                                        Learning Time

                                                                                                                                                                        Learning Time

                                                                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                        Asking two questionshellip

                                                                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                        this

                                                                                                                                                                        what

                                                                                                                                                                        I se

                                                                                                                                                                        t out

                                                                                                                                                                        to

                                                                                                                                                                        do

                                                                                                                                                                        bullYesbullYes

                                                                                                                                                                        bullNobullYes

                                                                                                                                                                        bullYesbullNo

                                                                                                                                                                        bullNobullNo

                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                        this

                                                                                                                                                                        what

                                                                                                                                                                        I se

                                                                                                                                                                        t out

                                                                                                                                                                        to

                                                                                                                                                                        do

                                                                                                                                                                        bullFunbullOn-task

                                                                                                                                                                        bullNot funbullOn-task

                                                                                                                                                                        bullFunbullNot on-task

                                                                                                                                                                        bullNot funbullNot on-task

                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                        Volkow et al 2004

                                                                                                                                                                        Increase salience

                                                                                                                                                                        Increase salience

                                                                                                                                                                        Quarterly QI review

                                                                                                                                                                        The post-mortem

                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                        Yoga read

                                                                                                                                                                        Staff meeting

                                                                                                                                                                        Planningsession

                                                                                                                                                                        Phone calls

                                                                                                                                                                        billing

                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                        Learn French

                                                                                                                                                                        Stop smoking

                                                                                                                                                                        Be a better spouse

                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                                        DavidNowell

                                                                                                                                                                        • Slide 1
                                                                                                                                                                        • hellipa challenge
                                                                                                                                                                        • Slide 3
                                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                        • Slide 7
                                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                                        • Overview
                                                                                                                                                                        • This Dense Pudding
                                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                                        • Slide 12
                                                                                                                                                                        • Slide 13
                                                                                                                                                                        • Developmental considerations
                                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                        • Slide 17
                                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                        • Slide 19
                                                                                                                                                                        • Strategies
                                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                                        • Slide 22
                                                                                                                                                                        • Slide 23
                                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                        • Slide 25
                                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                                        • Slide 27
                                                                                                                                                                        • Slide 28
                                                                                                                                                                        • Slide 29
                                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                        • Slide 35
                                                                                                                                                                        • Strategies (2)
                                                                                                                                                                        • (C)APD
                                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                                        • Self-assessment
                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                        • Slide 42
                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                        • Core symptoms
                                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                                        • Slide 49
                                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                                        • Slide 53
                                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                                        • Slide 63
                                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                                        • ADHD and girls
                                                                                                                                                                        • Slide 66
                                                                                                                                                                        • Slide 67
                                                                                                                                                                        • ADHD and women
                                                                                                                                                                        • Slide 69
                                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                                        • The Executive Functions
                                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                                        • Slide 74
                                                                                                                                                                        • Slide 75
                                                                                                                                                                        • Appropriate expectations
                                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                        • Slide 84
                                                                                                                                                                        • Slide 85
                                                                                                                                                                        • Strategies (3)
                                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                                        • Behavioral Supports
                                                                                                                                                                        • Slide 89
                                                                                                                                                                        • Slide 90
                                                                                                                                                                        • Slide 91
                                                                                                                                                                        • Slide 92
                                                                                                                                                                        • Slide 93
                                                                                                                                                                        • Slide 94
                                                                                                                                                                        • Slide 95
                                                                                                                                                                        • Slide 96
                                                                                                                                                                        • Slide 97
                                                                                                                                                                        • Slide 98
                                                                                                                                                                        • Slide 99
                                                                                                                                                                        • Slide 100
                                                                                                                                                                        • Slide 101
                                                                                                                                                                        • Slide 102
                                                                                                                                                                        • Slide 103
                                                                                                                                                                        • Slide 104
                                                                                                                                                                        • Slide 105
                                                                                                                                                                        • Slide 106
                                                                                                                                                                        • Slide 107
                                                                                                                                                                        • Slide 108
                                                                                                                                                                        • Slide 109
                                                                                                                                                                        • Slide 110
                                                                                                                                                                        • Time Out
                                                                                                                                                                        • Token economy
                                                                                                                                                                        • Slide 113
                                                                                                                                                                        • Slide 114
                                                                                                                                                                        • Slide 115
                                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                                        • Slide 117
                                                                                                                                                                        • Slide 118
                                                                                                                                                                        • Slide 119
                                                                                                                                                                        • Metacognition
                                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                        • Slide 124
                                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                        • Slide 128
                                                                                                                                                                        • Slide 129
                                                                                                                                                                        • Broaden and Build
                                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                        • Slide 141
                                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                        • Slide 146
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                        • Slide 149
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                        • Slide 152
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                        • Slide 154
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                        • Slide 157
                                                                                                                                                                        • Slide 158
                                                                                                                                                                        • Slide 159
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                        • Slide 162
                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                        • Slide 164
                                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                                        • Slide 166
                                                                                                                                                                        • Slide 167
                                                                                                                                                                        • Slide 168
                                                                                                                                                                        • Slide 169
                                                                                                                                                                        • Slide 170
                                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                                        • Match the Picture
                                                                                                                                                                        • Slide 176
                                                                                                                                                                        • Slide 177
                                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                                        • Slide 179
                                                                                                                                                                        • Slide 180
                                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                                        • Learning Time
                                                                                                                                                                        • Learning Time (2)
                                                                                                                                                                        • Learning Time (3)
                                                                                                                                                                        • Slide 185
                                                                                                                                                                        • Slide 186
                                                                                                                                                                        • Learning Time (4)
                                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                                        • Slide 189
                                                                                                                                                                        • Slide 190
                                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                        • Slide 194
                                                                                                                                                                        • Slide 195
                                                                                                                                                                        • Slide 196
                                                                                                                                                                        • Slide 197
                                                                                                                                                                        • Slide 198
                                                                                                                                                                        • Slide 199
                                                                                                                                                                        • Slide 200
                                                                                                                                                                        • Slide 201
                                                                                                                                                                        • Quarterly QI review
                                                                                                                                                                        • The post-mortem
                                                                                                                                                                        • Slide 204
                                                                                                                                                                        • Slide 205
                                                                                                                                                                        • Slide 206
                                                                                                                                                                        • Slide 207
                                                                                                                                                                        • Slide 208
                                                                                                                                                                        • Slide 209
                                                                                                                                                                        • Slide 210
                                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                                        • Slide 212
                                                                                                                                                                        • Slide 213
                                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                                        • Slide 215
                                                                                                                                                                        • Slide 216
                                                                                                                                                                        • Slide 217
                                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                                        • A challengehellip
                                                                                                                                                                        • Slide 222

                                                                                                                                                                          A B C

                                                                                                                                                                          behavior

                                                                                                                                                                          Metacognition

                                                                                                                                                                          Metacognitive knowledge Metacognitive strategies

                                                                                                                                                                          ldquoLend Me Your Brainrdquo

                                                                                                                                                                          What Does Dopamine Feel Like

                                                                                                                                                                          The Physiology of Motivation and Reward

                                                                                                                                                                          Preferred States What Does Dopamine Feel Like

                                                                                                                                                                          1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                          David D Nowell PhD189 May Street

                                                                                                                                                                          Worcester Mass 01602DrNowellcom

                                                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                                                          wwwLulucom

                                                                                                                                                                          Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                          highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                          of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                          clusters groupings There will probably be 4 or 5

                                                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                                                          Find a word a label for each of the groupings

                                                                                                                                                                          Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                          ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                          Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                                                          Broaden and Build

                                                                                                                                                                          ldquoNeuroMalleabilityrdquo

                                                                                                                                                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                          The reward-and-planning system

                                                                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                          The reward-and-planning system

                                                                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                          Lend Me Your Brain

                                                                                                                                                                          Supporting Clients with Executive Dysfunction

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                          Too busy with current activity

                                                                                                                                                                          Field dependent

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Sequence problem-solve

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Block out distractions

                                                                                                                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                          - E Goldberg

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Get the reward

                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                          Instant gratification vs

                                                                                                                                                                          executive gratification

                                                                                                                                                                          A B C

                                                                                                                                                                          behaviorx

                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                          takerdquordquo

                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                          thathelliprdquo

                                                                                                                                                                          Match the Picture

                                                                                                                                                                          Distraction Delay Training

                                                                                                                                                                          Executive Estimates Training

                                                                                                                                                                          X

                                                                                                                                                                          Learning Time

                                                                                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                          Learning Time

                                                                                                                                                                          Learning Time

                                                                                                                                                                          Learning Time

                                                                                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                          Asking two questionshellip

                                                                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                          this

                                                                                                                                                                          what

                                                                                                                                                                          I se

                                                                                                                                                                          t out

                                                                                                                                                                          to

                                                                                                                                                                          do

                                                                                                                                                                          bullYesbullYes

                                                                                                                                                                          bullNobullYes

                                                                                                                                                                          bullYesbullNo

                                                                                                                                                                          bullNobullNo

                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                          this

                                                                                                                                                                          what

                                                                                                                                                                          I se

                                                                                                                                                                          t out

                                                                                                                                                                          to

                                                                                                                                                                          do

                                                                                                                                                                          bullFunbullOn-task

                                                                                                                                                                          bullNot funbullOn-task

                                                                                                                                                                          bullFunbullNot on-task

                                                                                                                                                                          bullNot funbullNot on-task

                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                          Volkow et al 2004

                                                                                                                                                                          Increase salience

                                                                                                                                                                          Increase salience

                                                                                                                                                                          Quarterly QI review

                                                                                                                                                                          The post-mortem

                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                          Yoga read

                                                                                                                                                                          Staff meeting

                                                                                                                                                                          Planningsession

                                                                                                                                                                          Phone calls

                                                                                                                                                                          billing

                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                          Learn French

                                                                                                                                                                          Stop smoking

                                                                                                                                                                          Be a better spouse

                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                                          DavidNowell

                                                                                                                                                                          • Slide 1
                                                                                                                                                                          • hellipa challenge
                                                                                                                                                                          • Slide 3
                                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                          • Slide 7
                                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                                          • Overview
                                                                                                                                                                          • This Dense Pudding
                                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                                          • Slide 12
                                                                                                                                                                          • Slide 13
                                                                                                                                                                          • Developmental considerations
                                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                          • Slide 17
                                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                          • Slide 19
                                                                                                                                                                          • Strategies
                                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                                          • Slide 22
                                                                                                                                                                          • Slide 23
                                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                          • Slide 25
                                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                                          • Slide 27
                                                                                                                                                                          • Slide 28
                                                                                                                                                                          • Slide 29
                                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                          • Slide 35
                                                                                                                                                                          • Strategies (2)
                                                                                                                                                                          • (C)APD
                                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                                          • Self-assessment
                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                          • Slide 42
                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                          • Core symptoms
                                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                                          • Slide 49
                                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                                          • Slide 53
                                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                                          • Slide 63
                                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                                          • ADHD and girls
                                                                                                                                                                          • Slide 66
                                                                                                                                                                          • Slide 67
                                                                                                                                                                          • ADHD and women
                                                                                                                                                                          • Slide 69
                                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                                          • The Executive Functions
                                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                                          • Slide 74
                                                                                                                                                                          • Slide 75
                                                                                                                                                                          • Appropriate expectations
                                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                          • Slide 84
                                                                                                                                                                          • Slide 85
                                                                                                                                                                          • Strategies (3)
                                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                                          • Behavioral Supports
                                                                                                                                                                          • Slide 89
                                                                                                                                                                          • Slide 90
                                                                                                                                                                          • Slide 91
                                                                                                                                                                          • Slide 92
                                                                                                                                                                          • Slide 93
                                                                                                                                                                          • Slide 94
                                                                                                                                                                          • Slide 95
                                                                                                                                                                          • Slide 96
                                                                                                                                                                          • Slide 97
                                                                                                                                                                          • Slide 98
                                                                                                                                                                          • Slide 99
                                                                                                                                                                          • Slide 100
                                                                                                                                                                          • Slide 101
                                                                                                                                                                          • Slide 102
                                                                                                                                                                          • Slide 103
                                                                                                                                                                          • Slide 104
                                                                                                                                                                          • Slide 105
                                                                                                                                                                          • Slide 106
                                                                                                                                                                          • Slide 107
                                                                                                                                                                          • Slide 108
                                                                                                                                                                          • Slide 109
                                                                                                                                                                          • Slide 110
                                                                                                                                                                          • Time Out
                                                                                                                                                                          • Token economy
                                                                                                                                                                          • Slide 113
                                                                                                                                                                          • Slide 114
                                                                                                                                                                          • Slide 115
                                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                                          • Slide 117
                                                                                                                                                                          • Slide 118
                                                                                                                                                                          • Slide 119
                                                                                                                                                                          • Metacognition
                                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                          • Slide 124
                                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                          • Slide 128
                                                                                                                                                                          • Slide 129
                                                                                                                                                                          • Broaden and Build
                                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                          • Slide 141
                                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                          • Slide 146
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                          • Slide 149
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                          • Slide 152
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                          • Slide 154
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                          • Slide 157
                                                                                                                                                                          • Slide 158
                                                                                                                                                                          • Slide 159
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                          • Slide 162
                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                          • Slide 164
                                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                                          • Slide 166
                                                                                                                                                                          • Slide 167
                                                                                                                                                                          • Slide 168
                                                                                                                                                                          • Slide 169
                                                                                                                                                                          • Slide 170
                                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                                          • Match the Picture
                                                                                                                                                                          • Slide 176
                                                                                                                                                                          • Slide 177
                                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                                          • Slide 179
                                                                                                                                                                          • Slide 180
                                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                                          • Learning Time
                                                                                                                                                                          • Learning Time (2)
                                                                                                                                                                          • Learning Time (3)
                                                                                                                                                                          • Slide 185
                                                                                                                                                                          • Slide 186
                                                                                                                                                                          • Learning Time (4)
                                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                                          • Slide 189
                                                                                                                                                                          • Slide 190
                                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                          • Slide 194
                                                                                                                                                                          • Slide 195
                                                                                                                                                                          • Slide 196
                                                                                                                                                                          • Slide 197
                                                                                                                                                                          • Slide 198
                                                                                                                                                                          • Slide 199
                                                                                                                                                                          • Slide 200
                                                                                                                                                                          • Slide 201
                                                                                                                                                                          • Quarterly QI review
                                                                                                                                                                          • The post-mortem
                                                                                                                                                                          • Slide 204
                                                                                                                                                                          • Slide 205
                                                                                                                                                                          • Slide 206
                                                                                                                                                                          • Slide 207
                                                                                                                                                                          • Slide 208
                                                                                                                                                                          • Slide 209
                                                                                                                                                                          • Slide 210
                                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                                          • Slide 212
                                                                                                                                                                          • Slide 213
                                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                                          • Slide 215
                                                                                                                                                                          • Slide 216
                                                                                                                                                                          • Slide 217
                                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                                          • A challengehellip
                                                                                                                                                                          • Slide 222

                                                                                                                                                                            Metacognition

                                                                                                                                                                            Metacognitive knowledge Metacognitive strategies

                                                                                                                                                                            ldquoLend Me Your Brainrdquo

                                                                                                                                                                            What Does Dopamine Feel Like

                                                                                                                                                                            The Physiology of Motivation and Reward

                                                                                                                                                                            Preferred States What Does Dopamine Feel Like

                                                                                                                                                                            1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                            David D Nowell PhD189 May Street

                                                                                                                                                                            Worcester Mass 01602DrNowellcom

                                                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                                                            wwwLulucom

                                                                                                                                                                            Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                            highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                            of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                            clusters groupings There will probably be 4 or 5

                                                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                                                            Find a word a label for each of the groupings

                                                                                                                                                                            Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                            ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                            Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                                                            PREFERRED STATES INVENTORY

                                                                                                                                                                            Broaden and Build

                                                                                                                                                                            ldquoNeuroMalleabilityrdquo

                                                                                                                                                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                            The reward-and-planning system

                                                                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                            The reward-and-planning system

                                                                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                            Lend Me Your Brain

                                                                                                                                                                            Supporting Clients with Executive Dysfunction

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                            Too busy with current activity

                                                                                                                                                                            Field dependent

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Sequence problem-solve

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Block out distractions

                                                                                                                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                            - E Goldberg

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Get the reward

                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                            Instant gratification vs

                                                                                                                                                                            executive gratification

                                                                                                                                                                            A B C

                                                                                                                                                                            behaviorx

                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                            takerdquordquo

                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                            thathelliprdquo

                                                                                                                                                                            Match the Picture

                                                                                                                                                                            Distraction Delay Training

                                                                                                                                                                            Executive Estimates Training

                                                                                                                                                                            X

                                                                                                                                                                            Learning Time

                                                                                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                            Learning Time

                                                                                                                                                                            Learning Time

                                                                                                                                                                            Learning Time

                                                                                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                            Asking two questionshellip

                                                                                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                            this

                                                                                                                                                                            what

                                                                                                                                                                            I se

                                                                                                                                                                            t out

                                                                                                                                                                            to

                                                                                                                                                                            do

                                                                                                                                                                            bullYesbullYes

                                                                                                                                                                            bullNobullYes

                                                                                                                                                                            bullYesbullNo

                                                                                                                                                                            bullNobullNo

                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                            this

                                                                                                                                                                            what

                                                                                                                                                                            I se

                                                                                                                                                                            t out

                                                                                                                                                                            to

                                                                                                                                                                            do

                                                                                                                                                                            bullFunbullOn-task

                                                                                                                                                                            bullNot funbullOn-task

                                                                                                                                                                            bullFunbullNot on-task

                                                                                                                                                                            bullNot funbullNot on-task

                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                            Volkow et al 2004

                                                                                                                                                                            Increase salience

                                                                                                                                                                            Increase salience

                                                                                                                                                                            Quarterly QI review

                                                                                                                                                                            The post-mortem

                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                            Yoga read

                                                                                                                                                                            Staff meeting

                                                                                                                                                                            Planningsession

                                                                                                                                                                            Phone calls

                                                                                                                                                                            billing

                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                            Learn French

                                                                                                                                                                            Stop smoking

                                                                                                                                                                            Be a better spouse

                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                                            DavidNowell

                                                                                                                                                                            • Slide 1
                                                                                                                                                                            • hellipa challenge
                                                                                                                                                                            • Slide 3
                                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                            • Slide 7
                                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                                            • Overview
                                                                                                                                                                            • This Dense Pudding
                                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                                            • Slide 12
                                                                                                                                                                            • Slide 13
                                                                                                                                                                            • Developmental considerations
                                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                            • Slide 17
                                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                            • Slide 19
                                                                                                                                                                            • Strategies
                                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                                            • Slide 22
                                                                                                                                                                            • Slide 23
                                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                            • Slide 25
                                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                                            • Slide 27
                                                                                                                                                                            • Slide 28
                                                                                                                                                                            • Slide 29
                                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                            • Slide 35
                                                                                                                                                                            • Strategies (2)
                                                                                                                                                                            • (C)APD
                                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                                            • Self-assessment
                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                            • Slide 42
                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                            • Core symptoms
                                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                                            • Slide 49
                                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                                            • Slide 53
                                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                                            • Slide 63
                                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                                            • ADHD and girls
                                                                                                                                                                            • Slide 66
                                                                                                                                                                            • Slide 67
                                                                                                                                                                            • ADHD and women
                                                                                                                                                                            • Slide 69
                                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                                            • The Executive Functions
                                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                                            • Slide 74
                                                                                                                                                                            • Slide 75
                                                                                                                                                                            • Appropriate expectations
                                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                            • Slide 84
                                                                                                                                                                            • Slide 85
                                                                                                                                                                            • Strategies (3)
                                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                                            • Behavioral Supports
                                                                                                                                                                            • Slide 89
                                                                                                                                                                            • Slide 90
                                                                                                                                                                            • Slide 91
                                                                                                                                                                            • Slide 92
                                                                                                                                                                            • Slide 93
                                                                                                                                                                            • Slide 94
                                                                                                                                                                            • Slide 95
                                                                                                                                                                            • Slide 96
                                                                                                                                                                            • Slide 97
                                                                                                                                                                            • Slide 98
                                                                                                                                                                            • Slide 99
                                                                                                                                                                            • Slide 100
                                                                                                                                                                            • Slide 101
                                                                                                                                                                            • Slide 102
                                                                                                                                                                            • Slide 103
                                                                                                                                                                            • Slide 104
                                                                                                                                                                            • Slide 105
                                                                                                                                                                            • Slide 106
                                                                                                                                                                            • Slide 107
                                                                                                                                                                            • Slide 108
                                                                                                                                                                            • Slide 109
                                                                                                                                                                            • Slide 110
                                                                                                                                                                            • Time Out
                                                                                                                                                                            • Token economy
                                                                                                                                                                            • Slide 113
                                                                                                                                                                            • Slide 114
                                                                                                                                                                            • Slide 115
                                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                                            • Slide 117
                                                                                                                                                                            • Slide 118
                                                                                                                                                                            • Slide 119
                                                                                                                                                                            • Metacognition
                                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                            • Slide 124
                                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                            • Slide 128
                                                                                                                                                                            • Slide 129
                                                                                                                                                                            • Broaden and Build
                                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                            • Slide 141
                                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                            • Slide 146
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                            • Slide 149
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                            • Slide 152
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                            • Slide 154
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                            • Slide 157
                                                                                                                                                                            • Slide 158
                                                                                                                                                                            • Slide 159
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                            • Slide 162
                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                            • Slide 164
                                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                                            • Slide 166
                                                                                                                                                                            • Slide 167
                                                                                                                                                                            • Slide 168
                                                                                                                                                                            • Slide 169
                                                                                                                                                                            • Slide 170
                                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                                            • Match the Picture
                                                                                                                                                                            • Slide 176
                                                                                                                                                                            • Slide 177
                                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                                            • Slide 179
                                                                                                                                                                            • Slide 180
                                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                                            • Learning Time
                                                                                                                                                                            • Learning Time (2)
                                                                                                                                                                            • Learning Time (3)
                                                                                                                                                                            • Slide 185
                                                                                                                                                                            • Slide 186
                                                                                                                                                                            • Learning Time (4)
                                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                                            • Slide 189
                                                                                                                                                                            • Slide 190
                                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                            • Slide 194
                                                                                                                                                                            • Slide 195
                                                                                                                                                                            • Slide 196
                                                                                                                                                                            • Slide 197
                                                                                                                                                                            • Slide 198
                                                                                                                                                                            • Slide 199
                                                                                                                                                                            • Slide 200
                                                                                                                                                                            • Slide 201
                                                                                                                                                                            • Quarterly QI review
                                                                                                                                                                            • The post-mortem
                                                                                                                                                                            • Slide 204
                                                                                                                                                                            • Slide 205
                                                                                                                                                                            • Slide 206
                                                                                                                                                                            • Slide 207
                                                                                                                                                                            • Slide 208
                                                                                                                                                                            • Slide 209
                                                                                                                                                                            • Slide 210
                                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                                            • Slide 212
                                                                                                                                                                            • Slide 213
                                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                                            • Slide 215
                                                                                                                                                                            • Slide 216
                                                                                                                                                                            • Slide 217
                                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                                            • A challengehellip
                                                                                                                                                                            • Slide 222

                                                                                                                                                                              ldquoLend Me Your Brainrdquo

                                                                                                                                                                              What Does Dopamine Feel Like

                                                                                                                                                                              The Physiology of Motivation and Reward

                                                                                                                                                                              Preferred States What Does Dopamine Feel Like

                                                                                                                                                                              1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                              David D Nowell PhD189 May Street

                                                                                                                                                                              Worcester Mass 01602DrNowellcom

                                                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                                                              wwwLulucom

                                                                                                                                                                              Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                              highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                              of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                              clusters groupings There will probably be 4 or 5

                                                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                                                              Find a word a label for each of the groupings

                                                                                                                                                                              Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                              ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                              Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                                                              PREFERRED STATES INVENTORY

                                                                                                                                                                              Broaden and Build

                                                                                                                                                                              ldquoNeuroMalleabilityrdquo

                                                                                                                                                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                              The reward-and-planning system

                                                                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                              The reward-and-planning system

                                                                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                              Lend Me Your Brain

                                                                                                                                                                              Supporting Clients with Executive Dysfunction

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                              Too busy with current activity

                                                                                                                                                                              Field dependent

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Sequence problem-solve

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Block out distractions

                                                                                                                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                              - E Goldberg

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Get the reward

                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                              Instant gratification vs

                                                                                                                                                                              executive gratification

                                                                                                                                                                              A B C

                                                                                                                                                                              behaviorx

                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                              takerdquordquo

                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                              thathelliprdquo

                                                                                                                                                                              Match the Picture

                                                                                                                                                                              Distraction Delay Training

                                                                                                                                                                              Executive Estimates Training

                                                                                                                                                                              X

                                                                                                                                                                              Learning Time

                                                                                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                              Learning Time

                                                                                                                                                                              Learning Time

                                                                                                                                                                              Learning Time

                                                                                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                              Asking two questionshellip

                                                                                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                              this

                                                                                                                                                                              what

                                                                                                                                                                              I se

                                                                                                                                                                              t out

                                                                                                                                                                              to

                                                                                                                                                                              do

                                                                                                                                                                              bullYesbullYes

                                                                                                                                                                              bullNobullYes

                                                                                                                                                                              bullYesbullNo

                                                                                                                                                                              bullNobullNo

                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                              this

                                                                                                                                                                              what

                                                                                                                                                                              I se

                                                                                                                                                                              t out

                                                                                                                                                                              to

                                                                                                                                                                              do

                                                                                                                                                                              bullFunbullOn-task

                                                                                                                                                                              bullNot funbullOn-task

                                                                                                                                                                              bullFunbullNot on-task

                                                                                                                                                                              bullNot funbullNot on-task

                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                              Volkow et al 2004

                                                                                                                                                                              Increase salience

                                                                                                                                                                              Increase salience

                                                                                                                                                                              Quarterly QI review

                                                                                                                                                                              The post-mortem

                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                              Yoga read

                                                                                                                                                                              Staff meeting

                                                                                                                                                                              Planningsession

                                                                                                                                                                              Phone calls

                                                                                                                                                                              billing

                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                              Learn French

                                                                                                                                                                              Stop smoking

                                                                                                                                                                              Be a better spouse

                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                                              DavidNowell

                                                                                                                                                                              • Slide 1
                                                                                                                                                                              • hellipa challenge
                                                                                                                                                                              • Slide 3
                                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                              • Slide 7
                                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                                              • Overview
                                                                                                                                                                              • This Dense Pudding
                                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                                              • Slide 12
                                                                                                                                                                              • Slide 13
                                                                                                                                                                              • Developmental considerations
                                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                              • Slide 17
                                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                              • Slide 19
                                                                                                                                                                              • Strategies
                                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                                              • Slide 22
                                                                                                                                                                              • Slide 23
                                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                              • Slide 25
                                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                                              • Slide 27
                                                                                                                                                                              • Slide 28
                                                                                                                                                                              • Slide 29
                                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                              • Slide 35
                                                                                                                                                                              • Strategies (2)
                                                                                                                                                                              • (C)APD
                                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                                              • Self-assessment
                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                              • Slide 42
                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                              • Core symptoms
                                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                                              • Slide 49
                                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                                              • Slide 53
                                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                                              • Slide 63
                                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                                              • ADHD and girls
                                                                                                                                                                              • Slide 66
                                                                                                                                                                              • Slide 67
                                                                                                                                                                              • ADHD and women
                                                                                                                                                                              • Slide 69
                                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                                              • The Executive Functions
                                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                                              • Slide 74
                                                                                                                                                                              • Slide 75
                                                                                                                                                                              • Appropriate expectations
                                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                              • Slide 84
                                                                                                                                                                              • Slide 85
                                                                                                                                                                              • Strategies (3)
                                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                                              • Behavioral Supports
                                                                                                                                                                              • Slide 89
                                                                                                                                                                              • Slide 90
                                                                                                                                                                              • Slide 91
                                                                                                                                                                              • Slide 92
                                                                                                                                                                              • Slide 93
                                                                                                                                                                              • Slide 94
                                                                                                                                                                              • Slide 95
                                                                                                                                                                              • Slide 96
                                                                                                                                                                              • Slide 97
                                                                                                                                                                              • Slide 98
                                                                                                                                                                              • Slide 99
                                                                                                                                                                              • Slide 100
                                                                                                                                                                              • Slide 101
                                                                                                                                                                              • Slide 102
                                                                                                                                                                              • Slide 103
                                                                                                                                                                              • Slide 104
                                                                                                                                                                              • Slide 105
                                                                                                                                                                              • Slide 106
                                                                                                                                                                              • Slide 107
                                                                                                                                                                              • Slide 108
                                                                                                                                                                              • Slide 109
                                                                                                                                                                              • Slide 110
                                                                                                                                                                              • Time Out
                                                                                                                                                                              • Token economy
                                                                                                                                                                              • Slide 113
                                                                                                                                                                              • Slide 114
                                                                                                                                                                              • Slide 115
                                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                                              • Slide 117
                                                                                                                                                                              • Slide 118
                                                                                                                                                                              • Slide 119
                                                                                                                                                                              • Metacognition
                                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                              • Slide 124
                                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                              • Slide 128
                                                                                                                                                                              • Slide 129
                                                                                                                                                                              • Broaden and Build
                                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                              • Slide 141
                                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                              • Slide 146
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                              • Slide 149
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                              • Slide 152
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                              • Slide 154
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                              • Slide 157
                                                                                                                                                                              • Slide 158
                                                                                                                                                                              • Slide 159
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                              • Slide 162
                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                              • Slide 164
                                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                                              • Slide 166
                                                                                                                                                                              • Slide 167
                                                                                                                                                                              • Slide 168
                                                                                                                                                                              • Slide 169
                                                                                                                                                                              • Slide 170
                                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                                              • Match the Picture
                                                                                                                                                                              • Slide 176
                                                                                                                                                                              • Slide 177
                                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                                              • Slide 179
                                                                                                                                                                              • Slide 180
                                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                                              • Learning Time
                                                                                                                                                                              • Learning Time (2)
                                                                                                                                                                              • Learning Time (3)
                                                                                                                                                                              • Slide 185
                                                                                                                                                                              • Slide 186
                                                                                                                                                                              • Learning Time (4)
                                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                                              • Slide 189
                                                                                                                                                                              • Slide 190
                                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                              • Slide 194
                                                                                                                                                                              • Slide 195
                                                                                                                                                                              • Slide 196
                                                                                                                                                                              • Slide 197
                                                                                                                                                                              • Slide 198
                                                                                                                                                                              • Slide 199
                                                                                                                                                                              • Slide 200
                                                                                                                                                                              • Slide 201
                                                                                                                                                                              • Quarterly QI review
                                                                                                                                                                              • The post-mortem
                                                                                                                                                                              • Slide 204
                                                                                                                                                                              • Slide 205
                                                                                                                                                                              • Slide 206
                                                                                                                                                                              • Slide 207
                                                                                                                                                                              • Slide 208
                                                                                                                                                                              • Slide 209
                                                                                                                                                                              • Slide 210
                                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                                              • Slide 212
                                                                                                                                                                              • Slide 213
                                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                                              • Slide 215
                                                                                                                                                                              • Slide 216
                                                                                                                                                                              • Slide 217
                                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                                              • A challengehellip
                                                                                                                                                                              • Slide 222

                                                                                                                                                                                What Does Dopamine Feel Like

                                                                                                                                                                                The Physiology of Motivation and Reward

                                                                                                                                                                                Preferred States What Does Dopamine Feel Like

                                                                                                                                                                                1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                                David D Nowell PhD189 May Street

                                                                                                                                                                                Worcester Mass 01602DrNowellcom

                                                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                                                wwwLulucom

                                                                                                                                                                                Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                                highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                                of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                                clusters groupings There will probably be 4 or 5

                                                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                                                Find a word a label for each of the groupings

                                                                                                                                                                                Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                                ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                                Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                                                PREFERRED STATES INVENTORY

                                                                                                                                                                                Broaden and Build

                                                                                                                                                                                ldquoNeuroMalleabilityrdquo

                                                                                                                                                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                                The reward-and-planning system

                                                                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                The reward-and-planning system

                                                                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                Lend Me Your Brain

                                                                                                                                                                                Supporting Clients with Executive Dysfunction

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                Too busy with current activity

                                                                                                                                                                                Field dependent

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Sequence problem-solve

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Block out distractions

                                                                                                                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                - E Goldberg

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Get the reward

                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                Instant gratification vs

                                                                                                                                                                                executive gratification

                                                                                                                                                                                A B C

                                                                                                                                                                                behaviorx

                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                takerdquordquo

                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                thathelliprdquo

                                                                                                                                                                                Match the Picture

                                                                                                                                                                                Distraction Delay Training

                                                                                                                                                                                Executive Estimates Training

                                                                                                                                                                                X

                                                                                                                                                                                Learning Time

                                                                                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                Learning Time

                                                                                                                                                                                Learning Time

                                                                                                                                                                                Learning Time

                                                                                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                Asking two questionshellip

                                                                                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                this

                                                                                                                                                                                what

                                                                                                                                                                                I se

                                                                                                                                                                                t out

                                                                                                                                                                                to

                                                                                                                                                                                do

                                                                                                                                                                                bullYesbullYes

                                                                                                                                                                                bullNobullYes

                                                                                                                                                                                bullYesbullNo

                                                                                                                                                                                bullNobullNo

                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                this

                                                                                                                                                                                what

                                                                                                                                                                                I se

                                                                                                                                                                                t out

                                                                                                                                                                                to

                                                                                                                                                                                do

                                                                                                                                                                                bullFunbullOn-task

                                                                                                                                                                                bullNot funbullOn-task

                                                                                                                                                                                bullFunbullNot on-task

                                                                                                                                                                                bullNot funbullNot on-task

                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                Volkow et al 2004

                                                                                                                                                                                Increase salience

                                                                                                                                                                                Increase salience

                                                                                                                                                                                Quarterly QI review

                                                                                                                                                                                The post-mortem

                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                Yoga read

                                                                                                                                                                                Staff meeting

                                                                                                                                                                                Planningsession

                                                                                                                                                                                Phone calls

                                                                                                                                                                                billing

                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                Learn French

                                                                                                                                                                                Stop smoking

                                                                                                                                                                                Be a better spouse

                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                                DavidNowell

                                                                                                                                                                                • Slide 1
                                                                                                                                                                                • hellipa challenge
                                                                                                                                                                                • Slide 3
                                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                • Slide 7
                                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                                • Overview
                                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                                • Slide 12
                                                                                                                                                                                • Slide 13
                                                                                                                                                                                • Developmental considerations
                                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                • Slide 17
                                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                • Slide 19
                                                                                                                                                                                • Strategies
                                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                • Slide 22
                                                                                                                                                                                • Slide 23
                                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                • Slide 25
                                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                                • Slide 27
                                                                                                                                                                                • Slide 28
                                                                                                                                                                                • Slide 29
                                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                • Slide 35
                                                                                                                                                                                • Strategies (2)
                                                                                                                                                                                • (C)APD
                                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                                • Self-assessment
                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                • Slide 42
                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                • Core symptoms
                                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                                • Slide 49
                                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                                • Slide 53
                                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                                • Slide 63
                                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                                • ADHD and girls
                                                                                                                                                                                • Slide 66
                                                                                                                                                                                • Slide 67
                                                                                                                                                                                • ADHD and women
                                                                                                                                                                                • Slide 69
                                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                                • The Executive Functions
                                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                                • Slide 74
                                                                                                                                                                                • Slide 75
                                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                • Slide 84
                                                                                                                                                                                • Slide 85
                                                                                                                                                                                • Strategies (3)
                                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                                • Slide 89
                                                                                                                                                                                • Slide 90
                                                                                                                                                                                • Slide 91
                                                                                                                                                                                • Slide 92
                                                                                                                                                                                • Slide 93
                                                                                                                                                                                • Slide 94
                                                                                                                                                                                • Slide 95
                                                                                                                                                                                • Slide 96
                                                                                                                                                                                • Slide 97
                                                                                                                                                                                • Slide 98
                                                                                                                                                                                • Slide 99
                                                                                                                                                                                • Slide 100
                                                                                                                                                                                • Slide 101
                                                                                                                                                                                • Slide 102
                                                                                                                                                                                • Slide 103
                                                                                                                                                                                • Slide 104
                                                                                                                                                                                • Slide 105
                                                                                                                                                                                • Slide 106
                                                                                                                                                                                • Slide 107
                                                                                                                                                                                • Slide 108
                                                                                                                                                                                • Slide 109
                                                                                                                                                                                • Slide 110
                                                                                                                                                                                • Time Out
                                                                                                                                                                                • Token economy
                                                                                                                                                                                • Slide 113
                                                                                                                                                                                • Slide 114
                                                                                                                                                                                • Slide 115
                                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                                • Slide 117
                                                                                                                                                                                • Slide 118
                                                                                                                                                                                • Slide 119
                                                                                                                                                                                • Metacognition
                                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                • Slide 124
                                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                • Slide 128
                                                                                                                                                                                • Slide 129
                                                                                                                                                                                • Broaden and Build
                                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                • Slide 141
                                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                • Slide 146
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                • Slide 149
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                • Slide 152
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                • Slide 154
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                • Slide 157
                                                                                                                                                                                • Slide 158
                                                                                                                                                                                • Slide 159
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                • Slide 162
                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                • Slide 164
                                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                                • Slide 166
                                                                                                                                                                                • Slide 167
                                                                                                                                                                                • Slide 168
                                                                                                                                                                                • Slide 169
                                                                                                                                                                                • Slide 170
                                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                                • Match the Picture
                                                                                                                                                                                • Slide 176
                                                                                                                                                                                • Slide 177
                                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                                • Slide 179
                                                                                                                                                                                • Slide 180
                                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                                • Learning Time
                                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                                • Slide 185
                                                                                                                                                                                • Slide 186
                                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                                • Slide 189
                                                                                                                                                                                • Slide 190
                                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                • Slide 194
                                                                                                                                                                                • Slide 195
                                                                                                                                                                                • Slide 196
                                                                                                                                                                                • Slide 197
                                                                                                                                                                                • Slide 198
                                                                                                                                                                                • Slide 199
                                                                                                                                                                                • Slide 200
                                                                                                                                                                                • Slide 201
                                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                                • The post-mortem
                                                                                                                                                                                • Slide 204
                                                                                                                                                                                • Slide 205
                                                                                                                                                                                • Slide 206
                                                                                                                                                                                • Slide 207
                                                                                                                                                                                • Slide 208
                                                                                                                                                                                • Slide 209
                                                                                                                                                                                • Slide 210
                                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                                • Slide 212
                                                                                                                                                                                • Slide 213
                                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                • Slide 215
                                                                                                                                                                                • Slide 216
                                                                                                                                                                                • Slide 217
                                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                • A challengehellip
                                                                                                                                                                                • Slide 222

                                                                                                                                                                                  Preferred States What Does Dopamine Feel Like

                                                                                                                                                                                  1 Great experience2 Kodak moment3 The feeeeling

                                                                                                                                                                                  David D Nowell PhD189 May Street

                                                                                                                                                                                  Worcester Mass 01602DrNowellcom

                                                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                                                  wwwLulucom

                                                                                                                                                                                  Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                                  highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                                  of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                                  clusters groupings There will probably be 4 or 5

                                                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                                                  Find a word a label for each of the groupings

                                                                                                                                                                                  Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                                  ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                                  Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                                                  PREFERRED STATES INVENTORY

                                                                                                                                                                                  Broaden and Build

                                                                                                                                                                                  ldquoNeuroMalleabilityrdquo

                                                                                                                                                                                  Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                                  The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                                  The reward-and-planning system

                                                                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                  The reward-and-planning system

                                                                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                  Lend Me Your Brain

                                                                                                                                                                                  Supporting Clients with Executive Dysfunction

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                  Too busy with current activity

                                                                                                                                                                                  Field dependent

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Sequence problem-solve

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Block out distractions

                                                                                                                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                  - E Goldberg

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Get the reward

                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                  Instant gratification vs

                                                                                                                                                                                  executive gratification

                                                                                                                                                                                  A B C

                                                                                                                                                                                  behaviorx

                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                  takerdquordquo

                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                  thathelliprdquo

                                                                                                                                                                                  Match the Picture

                                                                                                                                                                                  Distraction Delay Training

                                                                                                                                                                                  Executive Estimates Training

                                                                                                                                                                                  X

                                                                                                                                                                                  Learning Time

                                                                                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                  Learning Time

                                                                                                                                                                                  Learning Time

                                                                                                                                                                                  Learning Time

                                                                                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                  Asking two questionshellip

                                                                                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                  this

                                                                                                                                                                                  what

                                                                                                                                                                                  I se

                                                                                                                                                                                  t out

                                                                                                                                                                                  to

                                                                                                                                                                                  do

                                                                                                                                                                                  bullYesbullYes

                                                                                                                                                                                  bullNobullYes

                                                                                                                                                                                  bullYesbullNo

                                                                                                                                                                                  bullNobullNo

                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                  this

                                                                                                                                                                                  what

                                                                                                                                                                                  I se

                                                                                                                                                                                  t out

                                                                                                                                                                                  to

                                                                                                                                                                                  do

                                                                                                                                                                                  bullFunbullOn-task

                                                                                                                                                                                  bullNot funbullOn-task

                                                                                                                                                                                  bullFunbullNot on-task

                                                                                                                                                                                  bullNot funbullNot on-task

                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                  Volkow et al 2004

                                                                                                                                                                                  Increase salience

                                                                                                                                                                                  Increase salience

                                                                                                                                                                                  Quarterly QI review

                                                                                                                                                                                  The post-mortem

                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                  Yoga read

                                                                                                                                                                                  Staff meeting

                                                                                                                                                                                  Planningsession

                                                                                                                                                                                  Phone calls

                                                                                                                                                                                  billing

                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                  Learn French

                                                                                                                                                                                  Stop smoking

                                                                                                                                                                                  Be a better spouse

                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                                  DavidNowell

                                                                                                                                                                                  • Slide 1
                                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                                  • Slide 3
                                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                  • Slide 7
                                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                                  • Overview
                                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                  • Slide 17
                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                  • Slide 19
                                                                                                                                                                                  • Strategies
                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                  • Slide 23
                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                  • Slide 25
                                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                                  • Slide 27
                                                                                                                                                                                  • Slide 28
                                                                                                                                                                                  • Slide 29
                                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                  • Slide 35
                                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                                  • (C)APD
                                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                                  • Self-assessment
                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                  • Slide 42
                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                  • Core symptoms
                                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                                  • Slide 53
                                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                                  • Slide 63
                                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                                  • Slide 66
                                                                                                                                                                                  • Slide 67
                                                                                                                                                                                  • ADHD and women
                                                                                                                                                                                  • Slide 69
                                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                                  • Slide 74
                                                                                                                                                                                  • Slide 75
                                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                  • Slide 84
                                                                                                                                                                                  • Slide 85
                                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                                  • Slide 89
                                                                                                                                                                                  • Slide 90
                                                                                                                                                                                  • Slide 91
                                                                                                                                                                                  • Slide 92
                                                                                                                                                                                  • Slide 93
                                                                                                                                                                                  • Slide 94
                                                                                                                                                                                  • Slide 95
                                                                                                                                                                                  • Slide 96
                                                                                                                                                                                  • Slide 97
                                                                                                                                                                                  • Slide 98
                                                                                                                                                                                  • Slide 99
                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                  • Slide 101
                                                                                                                                                                                  • Slide 102
                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                  • Slide 106
                                                                                                                                                                                  • Slide 107
                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                  • Slide 109
                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                  • Time Out
                                                                                                                                                                                  • Token economy
                                                                                                                                                                                  • Slide 113
                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                  • Slide 115
                                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                                  • Slide 117
                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                  • Metacognition
                                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                  • Slide 124
                                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                  • Slide 128
                                                                                                                                                                                  • Slide 129
                                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                  • Slide 141
                                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                  • Slide 146
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                  • Slide 149
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                  • Slide 152
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                  • Slide 154
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                  • Slide 157
                                                                                                                                                                                  • Slide 158
                                                                                                                                                                                  • Slide 159
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                  • Slide 162
                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                  • Slide 164
                                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                                  • Slide 166
                                                                                                                                                                                  • Slide 167
                                                                                                                                                                                  • Slide 168
                                                                                                                                                                                  • Slide 169
                                                                                                                                                                                  • Slide 170
                                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                                  • Match the Picture
                                                                                                                                                                                  • Slide 176
                                                                                                                                                                                  • Slide 177
                                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                                  • Slide 179
                                                                                                                                                                                  • Slide 180
                                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                                  • Learning Time
                                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                                  • Slide 185
                                                                                                                                                                                  • Slide 186
                                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                                  • Slide 189
                                                                                                                                                                                  • Slide 190
                                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                  • Slide 194
                                                                                                                                                                                  • Slide 195
                                                                                                                                                                                  • Slide 196
                                                                                                                                                                                  • Slide 197
                                                                                                                                                                                  • Slide 198
                                                                                                                                                                                  • Slide 199
                                                                                                                                                                                  • Slide 200
                                                                                                                                                                                  • Slide 201
                                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                                  • The post-mortem
                                                                                                                                                                                  • Slide 204
                                                                                                                                                                                  • Slide 205
                                                                                                                                                                                  • Slide 206
                                                                                                                                                                                  • Slide 207
                                                                                                                                                                                  • Slide 208
                                                                                                                                                                                  • Slide 209
                                                                                                                                                                                  • Slide 210
                                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                                  • Slide 212
                                                                                                                                                                                  • Slide 213
                                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                  • Slide 215
                                                                                                                                                                                  • Slide 216
                                                                                                                                                                                  • Slide 217
                                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                  • A challengehellip
                                                                                                                                                                                  • Slide 222

                                                                                                                                                                                    David D Nowell PhD189 May Street

                                                                                                                                                                                    Worcester Mass 01602DrNowellcom

                                                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                                                    wwwLulucom

                                                                                                                                                                                    Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                                    highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                                    of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                                    clusters groupings There will probably be 4 or 5

                                                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                                                    Find a word a label for each of the groupings

                                                                                                                                                                                    Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                                    ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                                    Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                                                    PREFERRED STATES INVENTORY

                                                                                                                                                                                    Broaden and Build

                                                                                                                                                                                    ldquoNeuroMalleabilityrdquo

                                                                                                                                                                                    Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                                    The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                                    The reward-and-planning system

                                                                                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                    The reward-and-planning system

                                                                                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                    Lend Me Your Brain

                                                                                                                                                                                    Supporting Clients with Executive Dysfunction

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                    Too busy with current activity

                                                                                                                                                                                    Field dependent

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Sequence problem-solve

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Block out distractions

                                                                                                                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                    - E Goldberg

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Get the reward

                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                    Instant gratification vs

                                                                                                                                                                                    executive gratification

                                                                                                                                                                                    A B C

                                                                                                                                                                                    behaviorx

                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                    takerdquordquo

                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                    thathelliprdquo

                                                                                                                                                                                    Match the Picture

                                                                                                                                                                                    Distraction Delay Training

                                                                                                                                                                                    Executive Estimates Training

                                                                                                                                                                                    X

                                                                                                                                                                                    Learning Time

                                                                                                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                    Learning Time

                                                                                                                                                                                    Learning Time

                                                                                                                                                                                    Learning Time

                                                                                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                    Asking two questionshellip

                                                                                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                    this

                                                                                                                                                                                    what

                                                                                                                                                                                    I se

                                                                                                                                                                                    t out

                                                                                                                                                                                    to

                                                                                                                                                                                    do

                                                                                                                                                                                    bullYesbullYes

                                                                                                                                                                                    bullNobullYes

                                                                                                                                                                                    bullYesbullNo

                                                                                                                                                                                    bullNobullNo

                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                    this

                                                                                                                                                                                    what

                                                                                                                                                                                    I se

                                                                                                                                                                                    t out

                                                                                                                                                                                    to

                                                                                                                                                                                    do

                                                                                                                                                                                    bullFunbullOn-task

                                                                                                                                                                                    bullNot funbullOn-task

                                                                                                                                                                                    bullFunbullNot on-task

                                                                                                                                                                                    bullNot funbullNot on-task

                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                    Volkow et al 2004

                                                                                                                                                                                    Increase salience

                                                                                                                                                                                    Increase salience

                                                                                                                                                                                    Quarterly QI review

                                                                                                                                                                                    The post-mortem

                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                    Yoga read

                                                                                                                                                                                    Staff meeting

                                                                                                                                                                                    Planningsession

                                                                                                                                                                                    Phone calls

                                                                                                                                                                                    billing

                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                    Learn French

                                                                                                                                                                                    Stop smoking

                                                                                                                                                                                    Be a better spouse

                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                                    DavidNowell

                                                                                                                                                                                    • Slide 1
                                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                                    • Slide 3
                                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                    • Slide 7
                                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                                    • Overview
                                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                    • Slide 17
                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                    • Slide 19
                                                                                                                                                                                    • Strategies
                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                    • Slide 23
                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                    • Slide 25
                                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                                    • Slide 27
                                                                                                                                                                                    • Slide 28
                                                                                                                                                                                    • Slide 29
                                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                    • Slide 35
                                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                                    • (C)APD
                                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                                    • Self-assessment
                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                    • Slide 42
                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                    • Core symptoms
                                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                                    • Slide 53
                                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                                    • Slide 63
                                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                                    • Slide 66
                                                                                                                                                                                    • Slide 67
                                                                                                                                                                                    • ADHD and women
                                                                                                                                                                                    • Slide 69
                                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                                    • Slide 74
                                                                                                                                                                                    • Slide 75
                                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                    • Slide 84
                                                                                                                                                                                    • Slide 85
                                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                                    • Slide 89
                                                                                                                                                                                    • Slide 90
                                                                                                                                                                                    • Slide 91
                                                                                                                                                                                    • Slide 92
                                                                                                                                                                                    • Slide 93
                                                                                                                                                                                    • Slide 94
                                                                                                                                                                                    • Slide 95
                                                                                                                                                                                    • Slide 96
                                                                                                                                                                                    • Slide 97
                                                                                                                                                                                    • Slide 98
                                                                                                                                                                                    • Slide 99
                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                    • Slide 101
                                                                                                                                                                                    • Slide 102
                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                    • Slide 106
                                                                                                                                                                                    • Slide 107
                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                    • Slide 109
                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                    • Time Out
                                                                                                                                                                                    • Token economy
                                                                                                                                                                                    • Slide 113
                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                    • Slide 115
                                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                                    • Slide 117
                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                    • Metacognition
                                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                    • Slide 124
                                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                    • Slide 128
                                                                                                                                                                                    • Slide 129
                                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                    • Slide 141
                                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                    • Slide 146
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                    • Slide 149
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                    • Slide 152
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                    • Slide 154
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                    • Slide 157
                                                                                                                                                                                    • Slide 158
                                                                                                                                                                                    • Slide 159
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                    • Slide 162
                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                    • Slide 164
                                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                                    • Slide 166
                                                                                                                                                                                    • Slide 167
                                                                                                                                                                                    • Slide 168
                                                                                                                                                                                    • Slide 169
                                                                                                                                                                                    • Slide 170
                                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                                    • Match the Picture
                                                                                                                                                                                    • Slide 176
                                                                                                                                                                                    • Slide 177
                                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                                    • Slide 179
                                                                                                                                                                                    • Slide 180
                                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                                    • Learning Time
                                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                                    • Slide 185
                                                                                                                                                                                    • Slide 186
                                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                                    • Slide 189
                                                                                                                                                                                    • Slide 190
                                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                    • Slide 194
                                                                                                                                                                                    • Slide 195
                                                                                                                                                                                    • Slide 196
                                                                                                                                                                                    • Slide 197
                                                                                                                                                                                    • Slide 198
                                                                                                                                                                                    • Slide 199
                                                                                                                                                                                    • Slide 200
                                                                                                                                                                                    • Slide 201
                                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                                    • The post-mortem
                                                                                                                                                                                    • Slide 204
                                                                                                                                                                                    • Slide 205
                                                                                                                                                                                    • Slide 206
                                                                                                                                                                                    • Slide 207
                                                                                                                                                                                    • Slide 208
                                                                                                                                                                                    • Slide 209
                                                                                                                                                                                    • Slide 210
                                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                                    • Slide 212
                                                                                                                                                                                    • Slide 213
                                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                    • Slide 215
                                                                                                                                                                                    • Slide 216
                                                                                                                                                                                    • Slide 217
                                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                    • A challengehellip
                                                                                                                                                                                    • Slide 222

                                                                                                                                                                                      Identify 20 peak experiences For each peak experience identify the

                                                                                                                                                                                      highlight moment ndash the snapshot Go to the visceralhellipwhat was the feeling

                                                                                                                                                                                      of that moment Name it Check the 20 peak moment-feelings for

                                                                                                                                                                                      clusters groupings There will probably be 4 or 5

                                                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                                                      Find a word a label for each of the groupings

                                                                                                                                                                                      Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                                      ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                                      Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                                                      PREFERRED STATES INVENTORY

                                                                                                                                                                                      Broaden and Build

                                                                                                                                                                                      ldquoNeuroMalleabilityrdquo

                                                                                                                                                                                      Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                                      The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                                      The reward-and-planning system

                                                                                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                      The reward-and-planning system

                                                                                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                      Lend Me Your Brain

                                                                                                                                                                                      Supporting Clients with Executive Dysfunction

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                      Too busy with current activity

                                                                                                                                                                                      Field dependent

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Sequence problem-solve

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Block out distractions

                                                                                                                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                      - E Goldberg

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Get the reward

                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                      Instant gratification vs

                                                                                                                                                                                      executive gratification

                                                                                                                                                                                      A B C

                                                                                                                                                                                      behaviorx

                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                      takerdquordquo

                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                      thathelliprdquo

                                                                                                                                                                                      Match the Picture

                                                                                                                                                                                      Distraction Delay Training

                                                                                                                                                                                      Executive Estimates Training

                                                                                                                                                                                      X

                                                                                                                                                                                      Learning Time

                                                                                                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                      Learning Time

                                                                                                                                                                                      Learning Time

                                                                                                                                                                                      Learning Time

                                                                                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                      Asking two questionshellip

                                                                                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                      this

                                                                                                                                                                                      what

                                                                                                                                                                                      I se

                                                                                                                                                                                      t out

                                                                                                                                                                                      to

                                                                                                                                                                                      do

                                                                                                                                                                                      bullYesbullYes

                                                                                                                                                                                      bullNobullYes

                                                                                                                                                                                      bullYesbullNo

                                                                                                                                                                                      bullNobullNo

                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                      this

                                                                                                                                                                                      what

                                                                                                                                                                                      I se

                                                                                                                                                                                      t out

                                                                                                                                                                                      to

                                                                                                                                                                                      do

                                                                                                                                                                                      bullFunbullOn-task

                                                                                                                                                                                      bullNot funbullOn-task

                                                                                                                                                                                      bullFunbullNot on-task

                                                                                                                                                                                      bullNot funbullNot on-task

                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                      Volkow et al 2004

                                                                                                                                                                                      Increase salience

                                                                                                                                                                                      Increase salience

                                                                                                                                                                                      Quarterly QI review

                                                                                                                                                                                      The post-mortem

                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                      Yoga read

                                                                                                                                                                                      Staff meeting

                                                                                                                                                                                      Planningsession

                                                                                                                                                                                      Phone calls

                                                                                                                                                                                      billing

                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                      Learn French

                                                                                                                                                                                      Stop smoking

                                                                                                                                                                                      Be a better spouse

                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                                                      DavidNowell

                                                                                                                                                                                      • Slide 1
                                                                                                                                                                                      • hellipa challenge
                                                                                                                                                                                      • Slide 3
                                                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                      • Slide 7
                                                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                                                      • Overview
                                                                                                                                                                                      • This Dense Pudding
                                                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                      • Developmental considerations
                                                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                      • Slide 17
                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                      • Slide 19
                                                                                                                                                                                      • Strategies
                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                      • Slide 23
                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                      • Slide 25
                                                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                                                      • Slide 27
                                                                                                                                                                                      • Slide 28
                                                                                                                                                                                      • Slide 29
                                                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                      • Slide 35
                                                                                                                                                                                      • Strategies (2)
                                                                                                                                                                                      • (C)APD
                                                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                                                      • Self-assessment
                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                      • Slide 42
                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                      • Core symptoms
                                                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                                                      • Slide 53
                                                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                                                      • Slide 63
                                                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                                                      • ADHD and girls
                                                                                                                                                                                      • Slide 66
                                                                                                                                                                                      • Slide 67
                                                                                                                                                                                      • ADHD and women
                                                                                                                                                                                      • Slide 69
                                                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                                                      • The Executive Functions
                                                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                                                      • Slide 74
                                                                                                                                                                                      • Slide 75
                                                                                                                                                                                      • Appropriate expectations
                                                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                      • Slide 84
                                                                                                                                                                                      • Slide 85
                                                                                                                                                                                      • Strategies (3)
                                                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                                                      • Behavioral Supports
                                                                                                                                                                                      • Slide 89
                                                                                                                                                                                      • Slide 90
                                                                                                                                                                                      • Slide 91
                                                                                                                                                                                      • Slide 92
                                                                                                                                                                                      • Slide 93
                                                                                                                                                                                      • Slide 94
                                                                                                                                                                                      • Slide 95
                                                                                                                                                                                      • Slide 96
                                                                                                                                                                                      • Slide 97
                                                                                                                                                                                      • Slide 98
                                                                                                                                                                                      • Slide 99
                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                      • Slide 101
                                                                                                                                                                                      • Slide 102
                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                      • Slide 106
                                                                                                                                                                                      • Slide 107
                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                      • Slide 109
                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                      • Time Out
                                                                                                                                                                                      • Token economy
                                                                                                                                                                                      • Slide 113
                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                      • Slide 115
                                                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                                                      • Slide 117
                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                      • Metacognition
                                                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                      • Slide 124
                                                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                      • Slide 128
                                                                                                                                                                                      • Slide 129
                                                                                                                                                                                      • Broaden and Build
                                                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                      • Slide 141
                                                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                      • Slide 146
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                      • Slide 149
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                      • Slide 152
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                      • Slide 154
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                      • Slide 157
                                                                                                                                                                                      • Slide 158
                                                                                                                                                                                      • Slide 159
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                      • Slide 162
                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                      • Slide 164
                                                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                                                      • Slide 166
                                                                                                                                                                                      • Slide 167
                                                                                                                                                                                      • Slide 168
                                                                                                                                                                                      • Slide 169
                                                                                                                                                                                      • Slide 170
                                                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                                                      • Match the Picture
                                                                                                                                                                                      • Slide 176
                                                                                                                                                                                      • Slide 177
                                                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                                                      • Slide 179
                                                                                                                                                                                      • Slide 180
                                                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                                                      • Learning Time
                                                                                                                                                                                      • Learning Time (2)
                                                                                                                                                                                      • Learning Time (3)
                                                                                                                                                                                      • Slide 185
                                                                                                                                                                                      • Slide 186
                                                                                                                                                                                      • Learning Time (4)
                                                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                                                      • Slide 189
                                                                                                                                                                                      • Slide 190
                                                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                      • Slide 194
                                                                                                                                                                                      • Slide 195
                                                                                                                                                                                      • Slide 196
                                                                                                                                                                                      • Slide 197
                                                                                                                                                                                      • Slide 198
                                                                                                                                                                                      • Slide 199
                                                                                                                                                                                      • Slide 200
                                                                                                                                                                                      • Slide 201
                                                                                                                                                                                      • Quarterly QI review
                                                                                                                                                                                      • The post-mortem
                                                                                                                                                                                      • Slide 204
                                                                                                                                                                                      • Slide 205
                                                                                                                                                                                      • Slide 206
                                                                                                                                                                                      • Slide 207
                                                                                                                                                                                      • Slide 208
                                                                                                                                                                                      • Slide 209
                                                                                                                                                                                      • Slide 210
                                                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                                                      • Slide 212
                                                                                                                                                                                      • Slide 213
                                                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                      • Slide 215
                                                                                                                                                                                      • Slide 216
                                                                                                                                                                                      • Slide 217
                                                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                      • A challengehellip
                                                                                                                                                                                      • Slide 222

                                                                                                                                                                                        Find a word a label for each of the groupings

                                                                                                                                                                                        Check for accuracy (ldquogutrdquo check) Those are your preferred states your

                                                                                                                                                                                        ldquovaluesrdquo ways that you really like to feel

                                                                                                                                                                                        Now you know your motivationhellipuse this knowledge to review your daily activities and planning

                                                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                                                        PREFERRED STATES INVENTORY

                                                                                                                                                                                        Broaden and Build

                                                                                                                                                                                        ldquoNeuroMalleabilityrdquo

                                                                                                                                                                                        Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                                        The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                                        The reward-and-planning system

                                                                                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                        ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                        The reward-and-planning system

                                                                                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                        Lend Me Your Brain

                                                                                                                                                                                        Supporting Clients with Executive Dysfunction

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                        Too busy with current activity

                                                                                                                                                                                        Field dependent

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Sequence problem-solve

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Block out distractions

                                                                                                                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                        - E Goldberg

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Get the reward

                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                        Instant gratification vs

                                                                                                                                                                                        executive gratification

                                                                                                                                                                                        A B C

                                                                                                                                                                                        behaviorx

                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                        takerdquordquo

                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                        thathelliprdquo

                                                                                                                                                                                        Match the Picture

                                                                                                                                                                                        Distraction Delay Training

                                                                                                                                                                                        Executive Estimates Training

                                                                                                                                                                                        X

                                                                                                                                                                                        Learning Time

                                                                                                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                        Learning Time

                                                                                                                                                                                        Learning Time

                                                                                                                                                                                        Learning Time

                                                                                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                        Asking two questionshellip

                                                                                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                        this

                                                                                                                                                                                        what

                                                                                                                                                                                        I se

                                                                                                                                                                                        t out

                                                                                                                                                                                        to

                                                                                                                                                                                        do

                                                                                                                                                                                        bullYesbullYes

                                                                                                                                                                                        bullNobullYes

                                                                                                                                                                                        bullYesbullNo

                                                                                                                                                                                        bullNobullNo

                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                        this

                                                                                                                                                                                        what

                                                                                                                                                                                        I se

                                                                                                                                                                                        t out

                                                                                                                                                                                        to

                                                                                                                                                                                        do

                                                                                                                                                                                        bullFunbullOn-task

                                                                                                                                                                                        bullNot funbullOn-task

                                                                                                                                                                                        bullFunbullNot on-task

                                                                                                                                                                                        bullNot funbullNot on-task

                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                        Volkow et al 2004

                                                                                                                                                                                        Increase salience

                                                                                                                                                                                        Increase salience

                                                                                                                                                                                        Quarterly QI review

                                                                                                                                                                                        The post-mortem

                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                        Yoga read

                                                                                                                                                                                        Staff meeting

                                                                                                                                                                                        Planningsession

                                                                                                                                                                                        Phone calls

                                                                                                                                                                                        billing

                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                        Learn French

                                                                                                                                                                                        Stop smoking

                                                                                                                                                                                        Be a better spouse

                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                                                        DavidNowell

                                                                                                                                                                                        • Slide 1
                                                                                                                                                                                        • hellipa challenge
                                                                                                                                                                                        • Slide 3
                                                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                        • Slide 7
                                                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                                                        • Overview
                                                                                                                                                                                        • This Dense Pudding
                                                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                        • Developmental considerations
                                                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                        • Slide 17
                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                        • Slide 19
                                                                                                                                                                                        • Strategies
                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                        • Slide 23
                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                        • Slide 25
                                                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                                                        • Slide 27
                                                                                                                                                                                        • Slide 28
                                                                                                                                                                                        • Slide 29
                                                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                        • Slide 35
                                                                                                                                                                                        • Strategies (2)
                                                                                                                                                                                        • (C)APD
                                                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                                                        • Self-assessment
                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                        • Slide 42
                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                        • Core symptoms
                                                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                                                        • Slide 53
                                                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                                                        • Slide 63
                                                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                                                        • ADHD and girls
                                                                                                                                                                                        • Slide 66
                                                                                                                                                                                        • Slide 67
                                                                                                                                                                                        • ADHD and women
                                                                                                                                                                                        • Slide 69
                                                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                                                        • The Executive Functions
                                                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                                                        • Slide 74
                                                                                                                                                                                        • Slide 75
                                                                                                                                                                                        • Appropriate expectations
                                                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                        • Slide 84
                                                                                                                                                                                        • Slide 85
                                                                                                                                                                                        • Strategies (3)
                                                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                                                        • Behavioral Supports
                                                                                                                                                                                        • Slide 89
                                                                                                                                                                                        • Slide 90
                                                                                                                                                                                        • Slide 91
                                                                                                                                                                                        • Slide 92
                                                                                                                                                                                        • Slide 93
                                                                                                                                                                                        • Slide 94
                                                                                                                                                                                        • Slide 95
                                                                                                                                                                                        • Slide 96
                                                                                                                                                                                        • Slide 97
                                                                                                                                                                                        • Slide 98
                                                                                                                                                                                        • Slide 99
                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                        • Slide 101
                                                                                                                                                                                        • Slide 102
                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                        • Slide 106
                                                                                                                                                                                        • Slide 107
                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                        • Slide 109
                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                        • Time Out
                                                                                                                                                                                        • Token economy
                                                                                                                                                                                        • Slide 113
                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                        • Slide 115
                                                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                                                        • Slide 117
                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                        • Metacognition
                                                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                        • Slide 124
                                                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                        • Slide 128
                                                                                                                                                                                        • Slide 129
                                                                                                                                                                                        • Broaden and Build
                                                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                        • Slide 141
                                                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                        • Slide 146
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                        • Slide 149
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                        • Slide 152
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                        • Slide 154
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                        • Slide 157
                                                                                                                                                                                        • Slide 158
                                                                                                                                                                                        • Slide 159
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                        • Slide 162
                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                        • Slide 164
                                                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                                                        • Slide 166
                                                                                                                                                                                        • Slide 167
                                                                                                                                                                                        • Slide 168
                                                                                                                                                                                        • Slide 169
                                                                                                                                                                                        • Slide 170
                                                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                                                        • Match the Picture
                                                                                                                                                                                        • Slide 176
                                                                                                                                                                                        • Slide 177
                                                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                                                        • Slide 179
                                                                                                                                                                                        • Slide 180
                                                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                                                        • Learning Time
                                                                                                                                                                                        • Learning Time (2)
                                                                                                                                                                                        • Learning Time (3)
                                                                                                                                                                                        • Slide 185
                                                                                                                                                                                        • Slide 186
                                                                                                                                                                                        • Learning Time (4)
                                                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                                                        • Slide 189
                                                                                                                                                                                        • Slide 190
                                                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                        • Slide 194
                                                                                                                                                                                        • Slide 195
                                                                                                                                                                                        • Slide 196
                                                                                                                                                                                        • Slide 197
                                                                                                                                                                                        • Slide 198
                                                                                                                                                                                        • Slide 199
                                                                                                                                                                                        • Slide 200
                                                                                                                                                                                        • Slide 201
                                                                                                                                                                                        • Quarterly QI review
                                                                                                                                                                                        • The post-mortem
                                                                                                                                                                                        • Slide 204
                                                                                                                                                                                        • Slide 205
                                                                                                                                                                                        • Slide 206
                                                                                                                                                                                        • Slide 207
                                                                                                                                                                                        • Slide 208
                                                                                                                                                                                        • Slide 209
                                                                                                                                                                                        • Slide 210
                                                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                                                        • Slide 212
                                                                                                                                                                                        • Slide 213
                                                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                        • Slide 215
                                                                                                                                                                                        • Slide 216
                                                                                                                                                                                        • Slide 217
                                                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                        • A challengehellip
                                                                                                                                                                                        • Slide 222

                                                                                                                                                                                          PREFERRED STATES INVENTORY

                                                                                                                                                                                          Broaden and Build

                                                                                                                                                                                          ldquoNeuroMalleabilityrdquo

                                                                                                                                                                                          Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                                          The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                                          The reward-and-planning system

                                                                                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                          ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                          The reward-and-planning system

                                                                                                                                                                                          Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                          Lend Me Your Brain

                                                                                                                                                                                          Supporting Clients with Executive Dysfunction

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                          Too busy with current activity

                                                                                                                                                                                          Field dependent

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Sequence problem-solve

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Block out distractions

                                                                                                                                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                          - E Goldberg

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Get the reward

                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                          Instant gratification vs

                                                                                                                                                                                          executive gratification

                                                                                                                                                                                          A B C

                                                                                                                                                                                          behaviorx

                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                          takerdquordquo

                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                          thathelliprdquo

                                                                                                                                                                                          Match the Picture

                                                                                                                                                                                          Distraction Delay Training

                                                                                                                                                                                          Executive Estimates Training

                                                                                                                                                                                          X

                                                                                                                                                                                          Learning Time

                                                                                                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                          Learning Time

                                                                                                                                                                                          Learning Time

                                                                                                                                                                                          Learning Time

                                                                                                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                          Asking two questionshellip

                                                                                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                          this

                                                                                                                                                                                          what

                                                                                                                                                                                          I se

                                                                                                                                                                                          t out

                                                                                                                                                                                          to

                                                                                                                                                                                          do

                                                                                                                                                                                          bullYesbullYes

                                                                                                                                                                                          bullNobullYes

                                                                                                                                                                                          bullYesbullNo

                                                                                                                                                                                          bullNobullNo

                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                          this

                                                                                                                                                                                          what

                                                                                                                                                                                          I se

                                                                                                                                                                                          t out

                                                                                                                                                                                          to

                                                                                                                                                                                          do

                                                                                                                                                                                          bullFunbullOn-task

                                                                                                                                                                                          bullNot funbullOn-task

                                                                                                                                                                                          bullFunbullNot on-task

                                                                                                                                                                                          bullNot funbullNot on-task

                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                          Volkow et al 2004

                                                                                                                                                                                          Increase salience

                                                                                                                                                                                          Increase salience

                                                                                                                                                                                          Quarterly QI review

                                                                                                                                                                                          The post-mortem

                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                          Yoga read

                                                                                                                                                                                          Staff meeting

                                                                                                                                                                                          Planningsession

                                                                                                                                                                                          Phone calls

                                                                                                                                                                                          billing

                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                          Learn French

                                                                                                                                                                                          Stop smoking

                                                                                                                                                                                          Be a better spouse

                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                                                          DavidNowell

                                                                                                                                                                                          • Slide 1
                                                                                                                                                                                          • hellipa challenge
                                                                                                                                                                                          • Slide 3
                                                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                          • Slide 7
                                                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                                                          • Overview
                                                                                                                                                                                          • This Dense Pudding
                                                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                          • Developmental considerations
                                                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                          • Slide 17
                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                          • Slide 19
                                                                                                                                                                                          • Strategies
                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                          • Slide 23
                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                          • Slide 25
                                                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                                                          • Slide 27
                                                                                                                                                                                          • Slide 28
                                                                                                                                                                                          • Slide 29
                                                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                          • Slide 35
                                                                                                                                                                                          • Strategies (2)
                                                                                                                                                                                          • (C)APD
                                                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                                                          • Self-assessment
                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                          • Slide 42
                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                          • Core symptoms
                                                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                                                          • Slide 53
                                                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                                                          • Slide 63
                                                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                                                          • ADHD and girls
                                                                                                                                                                                          • Slide 66
                                                                                                                                                                                          • Slide 67
                                                                                                                                                                                          • ADHD and women
                                                                                                                                                                                          • Slide 69
                                                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                                                          • The Executive Functions
                                                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                                                          • Slide 74
                                                                                                                                                                                          • Slide 75
                                                                                                                                                                                          • Appropriate expectations
                                                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                          • Slide 84
                                                                                                                                                                                          • Slide 85
                                                                                                                                                                                          • Strategies (3)
                                                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                                                          • Behavioral Supports
                                                                                                                                                                                          • Slide 89
                                                                                                                                                                                          • Slide 90
                                                                                                                                                                                          • Slide 91
                                                                                                                                                                                          • Slide 92
                                                                                                                                                                                          • Slide 93
                                                                                                                                                                                          • Slide 94
                                                                                                                                                                                          • Slide 95
                                                                                                                                                                                          • Slide 96
                                                                                                                                                                                          • Slide 97
                                                                                                                                                                                          • Slide 98
                                                                                                                                                                                          • Slide 99
                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                          • Slide 101
                                                                                                                                                                                          • Slide 102
                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                          • Slide 106
                                                                                                                                                                                          • Slide 107
                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                          • Slide 109
                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                          • Time Out
                                                                                                                                                                                          • Token economy
                                                                                                                                                                                          • Slide 113
                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                          • Slide 115
                                                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                                                          • Slide 117
                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                          • Metacognition
                                                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                          • Slide 124
                                                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                          • Slide 128
                                                                                                                                                                                          • Slide 129
                                                                                                                                                                                          • Broaden and Build
                                                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                          • Slide 141
                                                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                          • Slide 146
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                          • Slide 149
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                          • Slide 152
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                          • Slide 154
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                          • Slide 157
                                                                                                                                                                                          • Slide 158
                                                                                                                                                                                          • Slide 159
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                          • Slide 162
                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                          • Slide 164
                                                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                                                          • Slide 166
                                                                                                                                                                                          • Slide 167
                                                                                                                                                                                          • Slide 168
                                                                                                                                                                                          • Slide 169
                                                                                                                                                                                          • Slide 170
                                                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                                                          • Match the Picture
                                                                                                                                                                                          • Slide 176
                                                                                                                                                                                          • Slide 177
                                                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                                                          • Slide 179
                                                                                                                                                                                          • Slide 180
                                                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                                                          • Learning Time
                                                                                                                                                                                          • Learning Time (2)
                                                                                                                                                                                          • Learning Time (3)
                                                                                                                                                                                          • Slide 185
                                                                                                                                                                                          • Slide 186
                                                                                                                                                                                          • Learning Time (4)
                                                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                                                          • Slide 189
                                                                                                                                                                                          • Slide 190
                                                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                          • Slide 194
                                                                                                                                                                                          • Slide 195
                                                                                                                                                                                          • Slide 196
                                                                                                                                                                                          • Slide 197
                                                                                                                                                                                          • Slide 198
                                                                                                                                                                                          • Slide 199
                                                                                                                                                                                          • Slide 200
                                                                                                                                                                                          • Slide 201
                                                                                                                                                                                          • Quarterly QI review
                                                                                                                                                                                          • The post-mortem
                                                                                                                                                                                          • Slide 204
                                                                                                                                                                                          • Slide 205
                                                                                                                                                                                          • Slide 206
                                                                                                                                                                                          • Slide 207
                                                                                                                                                                                          • Slide 208
                                                                                                                                                                                          • Slide 209
                                                                                                                                                                                          • Slide 210
                                                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                                                          • Slide 212
                                                                                                                                                                                          • Slide 213
                                                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                          • Slide 215
                                                                                                                                                                                          • Slide 216
                                                                                                                                                                                          • Slide 217
                                                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                          • A challengehellip
                                                                                                                                                                                          • Slide 222

                                                                                                                                                                                            Broaden and Build

                                                                                                                                                                                            ldquoNeuroMalleabilityrdquo

                                                                                                                                                                                            Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                                            The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                                            The reward-and-planning system

                                                                                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                            ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                            The reward-and-planning system

                                                                                                                                                                                            Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                            Lend Me Your Brain

                                                                                                                                                                                            Supporting Clients with Executive Dysfunction

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                            Too busy with current activity

                                                                                                                                                                                            Field dependent

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Sequence problem-solve

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Block out distractions

                                                                                                                                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                            - E Goldberg

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Get the reward

                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                            Instant gratification vs

                                                                                                                                                                                            executive gratification

                                                                                                                                                                                            A B C

                                                                                                                                                                                            behaviorx

                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                            takerdquordquo

                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                            thathelliprdquo

                                                                                                                                                                                            Match the Picture

                                                                                                                                                                                            Distraction Delay Training

                                                                                                                                                                                            Executive Estimates Training

                                                                                                                                                                                            X

                                                                                                                                                                                            Learning Time

                                                                                                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                            Learning Time

                                                                                                                                                                                            Learning Time

                                                                                                                                                                                            Learning Time

                                                                                                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                            Asking two questionshellip

                                                                                                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                            this

                                                                                                                                                                                            what

                                                                                                                                                                                            I se

                                                                                                                                                                                            t out

                                                                                                                                                                                            to

                                                                                                                                                                                            do

                                                                                                                                                                                            bullYesbullYes

                                                                                                                                                                                            bullNobullYes

                                                                                                                                                                                            bullYesbullNo

                                                                                                                                                                                            bullNobullNo

                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                            this

                                                                                                                                                                                            what

                                                                                                                                                                                            I se

                                                                                                                                                                                            t out

                                                                                                                                                                                            to

                                                                                                                                                                                            do

                                                                                                                                                                                            bullFunbullOn-task

                                                                                                                                                                                            bullNot funbullOn-task

                                                                                                                                                                                            bullFunbullNot on-task

                                                                                                                                                                                            bullNot funbullNot on-task

                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                            Volkow et al 2004

                                                                                                                                                                                            Increase salience

                                                                                                                                                                                            Increase salience

                                                                                                                                                                                            Quarterly QI review

                                                                                                                                                                                            The post-mortem

                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                            Yoga read

                                                                                                                                                                                            Staff meeting

                                                                                                                                                                                            Planningsession

                                                                                                                                                                                            Phone calls

                                                                                                                                                                                            billing

                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                            Learn French

                                                                                                                                                                                            Stop smoking

                                                                                                                                                                                            Be a better spouse

                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                                                            DavidNowell

                                                                                                                                                                                            • Slide 1
                                                                                                                                                                                            • hellipa challenge
                                                                                                                                                                                            • Slide 3
                                                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                            • Slide 7
                                                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                                                            • Overview
                                                                                                                                                                                            • This Dense Pudding
                                                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                            • Developmental considerations
                                                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                            • Slide 17
                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                            • Slide 19
                                                                                                                                                                                            • Strategies
                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                            • Slide 23
                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                            • Slide 25
                                                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                                                            • Slide 27
                                                                                                                                                                                            • Slide 28
                                                                                                                                                                                            • Slide 29
                                                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                            • Slide 35
                                                                                                                                                                                            • Strategies (2)
                                                                                                                                                                                            • (C)APD
                                                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                                                            • Self-assessment
                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                            • Slide 42
                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                            • Core symptoms
                                                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                                                            • Slide 53
                                                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                                                            • Slide 63
                                                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                                                            • ADHD and girls
                                                                                                                                                                                            • Slide 66
                                                                                                                                                                                            • Slide 67
                                                                                                                                                                                            • ADHD and women
                                                                                                                                                                                            • Slide 69
                                                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                                                            • The Executive Functions
                                                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                                                            • Slide 74
                                                                                                                                                                                            • Slide 75
                                                                                                                                                                                            • Appropriate expectations
                                                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                            • Slide 84
                                                                                                                                                                                            • Slide 85
                                                                                                                                                                                            • Strategies (3)
                                                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                                                            • Behavioral Supports
                                                                                                                                                                                            • Slide 89
                                                                                                                                                                                            • Slide 90
                                                                                                                                                                                            • Slide 91
                                                                                                                                                                                            • Slide 92
                                                                                                                                                                                            • Slide 93
                                                                                                                                                                                            • Slide 94
                                                                                                                                                                                            • Slide 95
                                                                                                                                                                                            • Slide 96
                                                                                                                                                                                            • Slide 97
                                                                                                                                                                                            • Slide 98
                                                                                                                                                                                            • Slide 99
                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                            • Slide 101
                                                                                                                                                                                            • Slide 102
                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                            • Slide 106
                                                                                                                                                                                            • Slide 107
                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                            • Slide 109
                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                            • Time Out
                                                                                                                                                                                            • Token economy
                                                                                                                                                                                            • Slide 113
                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                            • Slide 115
                                                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                                                            • Slide 117
                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                            • Metacognition
                                                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                            • Slide 124
                                                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                            • Slide 128
                                                                                                                                                                                            • Slide 129
                                                                                                                                                                                            • Broaden and Build
                                                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                            • Slide 141
                                                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                            • Slide 146
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                            • Slide 149
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                            • Slide 152
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                            • Slide 154
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                            • Slide 157
                                                                                                                                                                                            • Slide 158
                                                                                                                                                                                            • Slide 159
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                            • Slide 162
                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                            • Slide 164
                                                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                                                            • Slide 166
                                                                                                                                                                                            • Slide 167
                                                                                                                                                                                            • Slide 168
                                                                                                                                                                                            • Slide 169
                                                                                                                                                                                            • Slide 170
                                                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                                                            • Match the Picture
                                                                                                                                                                                            • Slide 176
                                                                                                                                                                                            • Slide 177
                                                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                                                            • Slide 179
                                                                                                                                                                                            • Slide 180
                                                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                                                            • Learning Time
                                                                                                                                                                                            • Learning Time (2)
                                                                                                                                                                                            • Learning Time (3)
                                                                                                                                                                                            • Slide 185
                                                                                                                                                                                            • Slide 186
                                                                                                                                                                                            • Learning Time (4)
                                                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                                                            • Slide 189
                                                                                                                                                                                            • Slide 190
                                                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                            • Slide 194
                                                                                                                                                                                            • Slide 195
                                                                                                                                                                                            • Slide 196
                                                                                                                                                                                            • Slide 197
                                                                                                                                                                                            • Slide 198
                                                                                                                                                                                            • Slide 199
                                                                                                                                                                                            • Slide 200
                                                                                                                                                                                            • Slide 201
                                                                                                                                                                                            • Quarterly QI review
                                                                                                                                                                                            • The post-mortem
                                                                                                                                                                                            • Slide 204
                                                                                                                                                                                            • Slide 205
                                                                                                                                                                                            • Slide 206
                                                                                                                                                                                            • Slide 207
                                                                                                                                                                                            • Slide 208
                                                                                                                                                                                            • Slide 209
                                                                                                                                                                                            • Slide 210
                                                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                                                            • Slide 212
                                                                                                                                                                                            • Slide 213
                                                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                            • Slide 215
                                                                                                                                                                                            • Slide 216
                                                                                                                                                                                            • Slide 217
                                                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                            • A challengehellip
                                                                                                                                                                                            • Slide 222

                                                                                                                                                                                              ldquoNeuroMalleabilityrdquo

                                                                                                                                                                                              Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                                              The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                                              The reward-and-planning system

                                                                                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                              ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                              The reward-and-planning system

                                                                                                                                                                                              Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                              Lend Me Your Brain

                                                                                                                                                                                              Supporting Clients with Executive Dysfunction

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                              Too busy with current activity

                                                                                                                                                                                              Field dependent

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Sequence problem-solve

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Block out distractions

                                                                                                                                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                              - E Goldberg

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Get the reward

                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                              Instant gratification vs

                                                                                                                                                                                              executive gratification

                                                                                                                                                                                              A B C

                                                                                                                                                                                              behaviorx

                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                              takerdquordquo

                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                              thathelliprdquo

                                                                                                                                                                                              Match the Picture

                                                                                                                                                                                              Distraction Delay Training

                                                                                                                                                                                              Executive Estimates Training

                                                                                                                                                                                              X

                                                                                                                                                                                              Learning Time

                                                                                                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                              Learning Time

                                                                                                                                                                                              Learning Time

                                                                                                                                                                                              Learning Time

                                                                                                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                              Asking two questionshellip

                                                                                                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                              this

                                                                                                                                                                                              what

                                                                                                                                                                                              I se

                                                                                                                                                                                              t out

                                                                                                                                                                                              to

                                                                                                                                                                                              do

                                                                                                                                                                                              bullYesbullYes

                                                                                                                                                                                              bullNobullYes

                                                                                                                                                                                              bullYesbullNo

                                                                                                                                                                                              bullNobullNo

                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                              this

                                                                                                                                                                                              what

                                                                                                                                                                                              I se

                                                                                                                                                                                              t out

                                                                                                                                                                                              to

                                                                                                                                                                                              do

                                                                                                                                                                                              bullFunbullOn-task

                                                                                                                                                                                              bullNot funbullOn-task

                                                                                                                                                                                              bullFunbullNot on-task

                                                                                                                                                                                              bullNot funbullNot on-task

                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                              Volkow et al 2004

                                                                                                                                                                                              Increase salience

                                                                                                                                                                                              Increase salience

                                                                                                                                                                                              Quarterly QI review

                                                                                                                                                                                              The post-mortem

                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                              Yoga read

                                                                                                                                                                                              Staff meeting

                                                                                                                                                                                              Planningsession

                                                                                                                                                                                              Phone calls

                                                                                                                                                                                              billing

                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                              Learn French

                                                                                                                                                                                              Stop smoking

                                                                                                                                                                                              Be a better spouse

                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                                                              DavidNowell

                                                                                                                                                                                              • Slide 1
                                                                                                                                                                                              • hellipa challenge
                                                                                                                                                                                              • Slide 3
                                                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                              • Slide 7
                                                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                                                              • Overview
                                                                                                                                                                                              • This Dense Pudding
                                                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                              • Developmental considerations
                                                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                              • Slide 17
                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                              • Slide 19
                                                                                                                                                                                              • Strategies
                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                              • Slide 23
                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                              • Slide 25
                                                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                                                              • Slide 27
                                                                                                                                                                                              • Slide 28
                                                                                                                                                                                              • Slide 29
                                                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                              • Slide 35
                                                                                                                                                                                              • Strategies (2)
                                                                                                                                                                                              • (C)APD
                                                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                                                              • Self-assessment
                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                              • Slide 42
                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                              • Core symptoms
                                                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                                                              • Slide 53
                                                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                                                              • Slide 63
                                                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                                                              • ADHD and girls
                                                                                                                                                                                              • Slide 66
                                                                                                                                                                                              • Slide 67
                                                                                                                                                                                              • ADHD and women
                                                                                                                                                                                              • Slide 69
                                                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                                                              • The Executive Functions
                                                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                                                              • Slide 74
                                                                                                                                                                                              • Slide 75
                                                                                                                                                                                              • Appropriate expectations
                                                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                              • Slide 84
                                                                                                                                                                                              • Slide 85
                                                                                                                                                                                              • Strategies (3)
                                                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                                                              • Behavioral Supports
                                                                                                                                                                                              • Slide 89
                                                                                                                                                                                              • Slide 90
                                                                                                                                                                                              • Slide 91
                                                                                                                                                                                              • Slide 92
                                                                                                                                                                                              • Slide 93
                                                                                                                                                                                              • Slide 94
                                                                                                                                                                                              • Slide 95
                                                                                                                                                                                              • Slide 96
                                                                                                                                                                                              • Slide 97
                                                                                                                                                                                              • Slide 98
                                                                                                                                                                                              • Slide 99
                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                              • Slide 101
                                                                                                                                                                                              • Slide 102
                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                              • Slide 106
                                                                                                                                                                                              • Slide 107
                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                              • Slide 109
                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                              • Time Out
                                                                                                                                                                                              • Token economy
                                                                                                                                                                                              • Slide 113
                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                              • Slide 115
                                                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                                                              • Slide 117
                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                              • Metacognition
                                                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                              • Slide 124
                                                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                              • Slide 128
                                                                                                                                                                                              • Slide 129
                                                                                                                                                                                              • Broaden and Build
                                                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                              • Slide 141
                                                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                              • Slide 146
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                              • Slide 149
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                              • Slide 152
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                              • Slide 154
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                              • Slide 157
                                                                                                                                                                                              • Slide 158
                                                                                                                                                                                              • Slide 159
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                              • Slide 162
                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                              • Slide 164
                                                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                                                              • Slide 166
                                                                                                                                                                                              • Slide 167
                                                                                                                                                                                              • Slide 168
                                                                                                                                                                                              • Slide 169
                                                                                                                                                                                              • Slide 170
                                                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                                                              • Match the Picture
                                                                                                                                                                                              • Slide 176
                                                                                                                                                                                              • Slide 177
                                                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                                                              • Slide 179
                                                                                                                                                                                              • Slide 180
                                                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                                                              • Learning Time
                                                                                                                                                                                              • Learning Time (2)
                                                                                                                                                                                              • Learning Time (3)
                                                                                                                                                                                              • Slide 185
                                                                                                                                                                                              • Slide 186
                                                                                                                                                                                              • Learning Time (4)
                                                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                                                              • Slide 189
                                                                                                                                                                                              • Slide 190
                                                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                              • Slide 194
                                                                                                                                                                                              • Slide 195
                                                                                                                                                                                              • Slide 196
                                                                                                                                                                                              • Slide 197
                                                                                                                                                                                              • Slide 198
                                                                                                                                                                                              • Slide 199
                                                                                                                                                                                              • Slide 200
                                                                                                                                                                                              • Slide 201
                                                                                                                                                                                              • Quarterly QI review
                                                                                                                                                                                              • The post-mortem
                                                                                                                                                                                              • Slide 204
                                                                                                                                                                                              • Slide 205
                                                                                                                                                                                              • Slide 206
                                                                                                                                                                                              • Slide 207
                                                                                                                                                                                              • Slide 208
                                                                                                                                                                                              • Slide 209
                                                                                                                                                                                              • Slide 210
                                                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                                                              • Slide 212
                                                                                                                                                                                              • Slide 213
                                                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                              • Slide 215
                                                                                                                                                                                              • Slide 216
                                                                                                                                                                                              • Slide 217
                                                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                              • A challengehellip
                                                                                                                                                                                              • Slide 222

                                                                                                                                                                                                Why You Arenrsquot Getting Exactly What You Want All the Time

                                                                                                                                                                                                The Brainrsquos Reward and Planning System - And How It Breaks Down

                                                                                                                                                                                                The reward-and-planning system

                                                                                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                                ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                                The reward-and-planning system

                                                                                                                                                                                                Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                                Lend Me Your Brain

                                                                                                                                                                                                Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                Too busy with current activity

                                                                                                                                                                                                Field dependent

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Sequence problem-solve

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Block out distractions

                                                                                                                                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                - E Goldberg

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Get the reward

                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                Instant gratification vs

                                                                                                                                                                                                executive gratification

                                                                                                                                                                                                A B C

                                                                                                                                                                                                behaviorx

                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                takerdquordquo

                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                thathelliprdquo

                                                                                                                                                                                                Match the Picture

                                                                                                                                                                                                Distraction Delay Training

                                                                                                                                                                                                Executive Estimates Training

                                                                                                                                                                                                X

                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                Asking two questionshellip

                                                                                                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                this

                                                                                                                                                                                                what

                                                                                                                                                                                                I se

                                                                                                                                                                                                t out

                                                                                                                                                                                                to

                                                                                                                                                                                                do

                                                                                                                                                                                                bullYesbullYes

                                                                                                                                                                                                bullNobullYes

                                                                                                                                                                                                bullYesbullNo

                                                                                                                                                                                                bullNobullNo

                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                this

                                                                                                                                                                                                what

                                                                                                                                                                                                I se

                                                                                                                                                                                                t out

                                                                                                                                                                                                to

                                                                                                                                                                                                do

                                                                                                                                                                                                bullFunbullOn-task

                                                                                                                                                                                                bullNot funbullOn-task

                                                                                                                                                                                                bullFunbullNot on-task

                                                                                                                                                                                                bullNot funbullNot on-task

                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                Volkow et al 2004

                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                Quarterly QI review

                                                                                                                                                                                                The post-mortem

                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                Yoga read

                                                                                                                                                                                                Staff meeting

                                                                                                                                                                                                Planningsession

                                                                                                                                                                                                Phone calls

                                                                                                                                                                                                billing

                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                Learn French

                                                                                                                                                                                                Stop smoking

                                                                                                                                                                                                Be a better spouse

                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                                                DavidNowell

                                                                                                                                                                                                • Slide 1
                                                                                                                                                                                                • hellipa challenge
                                                                                                                                                                                                • Slide 3
                                                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                • Slide 7
                                                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                • Overview
                                                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                • Developmental considerations
                                                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                • Slide 17
                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                • Slide 19
                                                                                                                                                                                                • Strategies
                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                • Slide 23
                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                • Slide 25
                                                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                                                • Slide 27
                                                                                                                                                                                                • Slide 28
                                                                                                                                                                                                • Slide 29
                                                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                • Slide 35
                                                                                                                                                                                                • Strategies (2)
                                                                                                                                                                                                • (C)APD
                                                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                                                • Self-assessment
                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                • Slide 42
                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                • Core symptoms
                                                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                                                • Slide 53
                                                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                                                • Slide 63
                                                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                                                • ADHD and girls
                                                                                                                                                                                                • Slide 66
                                                                                                                                                                                                • Slide 67
                                                                                                                                                                                                • ADHD and women
                                                                                                                                                                                                • Slide 69
                                                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                                                • The Executive Functions
                                                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                                                • Slide 74
                                                                                                                                                                                                • Slide 75
                                                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                • Slide 84
                                                                                                                                                                                                • Slide 85
                                                                                                                                                                                                • Strategies (3)
                                                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                                                • Slide 89
                                                                                                                                                                                                • Slide 90
                                                                                                                                                                                                • Slide 91
                                                                                                                                                                                                • Slide 92
                                                                                                                                                                                                • Slide 93
                                                                                                                                                                                                • Slide 94
                                                                                                                                                                                                • Slide 95
                                                                                                                                                                                                • Slide 96
                                                                                                                                                                                                • Slide 97
                                                                                                                                                                                                • Slide 98
                                                                                                                                                                                                • Slide 99
                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                • Slide 101
                                                                                                                                                                                                • Slide 102
                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                • Slide 106
                                                                                                                                                                                                • Slide 107
                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                • Slide 109
                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                • Time Out
                                                                                                                                                                                                • Token economy
                                                                                                                                                                                                • Slide 113
                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                • Slide 115
                                                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                                                • Slide 117
                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                • Metacognition
                                                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                • Slide 124
                                                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                • Slide 128
                                                                                                                                                                                                • Slide 129
                                                                                                                                                                                                • Broaden and Build
                                                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                • Slide 141
                                                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                • Slide 146
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                • Slide 149
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                • Slide 152
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                • Slide 154
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                • Slide 157
                                                                                                                                                                                                • Slide 158
                                                                                                                                                                                                • Slide 159
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                • Slide 162
                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                • Slide 164
                                                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                                                • Slide 166
                                                                                                                                                                                                • Slide 167
                                                                                                                                                                                                • Slide 168
                                                                                                                                                                                                • Slide 169
                                                                                                                                                                                                • Slide 170
                                                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                                                • Match the Picture
                                                                                                                                                                                                • Slide 176
                                                                                                                                                                                                • Slide 177
                                                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                                                • Slide 179
                                                                                                                                                                                                • Slide 180
                                                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                                                • Learning Time
                                                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                                                • Slide 185
                                                                                                                                                                                                • Slide 186
                                                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                                                • Slide 189
                                                                                                                                                                                                • Slide 190
                                                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                • Slide 194
                                                                                                                                                                                                • Slide 195
                                                                                                                                                                                                • Slide 196
                                                                                                                                                                                                • Slide 197
                                                                                                                                                                                                • Slide 198
                                                                                                                                                                                                • Slide 199
                                                                                                                                                                                                • Slide 200
                                                                                                                                                                                                • Slide 201
                                                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                                                • The post-mortem
                                                                                                                                                                                                • Slide 204
                                                                                                                                                                                                • Slide 205
                                                                                                                                                                                                • Slide 206
                                                                                                                                                                                                • Slide 207
                                                                                                                                                                                                • Slide 208
                                                                                                                                                                                                • Slide 209
                                                                                                                                                                                                • Slide 210
                                                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                                                • Slide 212
                                                                                                                                                                                                • Slide 213
                                                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                • Slide 215
                                                                                                                                                                                                • Slide 216
                                                                                                                                                                                                • Slide 217
                                                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                • A challengehellip
                                                                                                                                                                                                • Slide 222

                                                                                                                                                                                                  The reward-and-planning system

                                                                                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                                  ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                                  The reward-and-planning system

                                                                                                                                                                                                  Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                                  Lend Me Your Brain

                                                                                                                                                                                                  Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                  Too busy with current activity

                                                                                                                                                                                                  Field dependent

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Sequence problem-solve

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Block out distractions

                                                                                                                                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                  - E Goldberg

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Get the reward

                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                  Instant gratification vs

                                                                                                                                                                                                  executive gratification

                                                                                                                                                                                                  A B C

                                                                                                                                                                                                  behaviorx

                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                  takerdquordquo

                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                  thathelliprdquo

                                                                                                                                                                                                  Match the Picture

                                                                                                                                                                                                  Distraction Delay Training

                                                                                                                                                                                                  Executive Estimates Training

                                                                                                                                                                                                  X

                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                  Asking two questionshellip

                                                                                                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                  this

                                                                                                                                                                                                  what

                                                                                                                                                                                                  I se

                                                                                                                                                                                                  t out

                                                                                                                                                                                                  to

                                                                                                                                                                                                  do

                                                                                                                                                                                                  bullYesbullYes

                                                                                                                                                                                                  bullNobullYes

                                                                                                                                                                                                  bullYesbullNo

                                                                                                                                                                                                  bullNobullNo

                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                  this

                                                                                                                                                                                                  what

                                                                                                                                                                                                  I se

                                                                                                                                                                                                  t out

                                                                                                                                                                                                  to

                                                                                                                                                                                                  do

                                                                                                                                                                                                  bullFunbullOn-task

                                                                                                                                                                                                  bullNot funbullOn-task

                                                                                                                                                                                                  bullFunbullNot on-task

                                                                                                                                                                                                  bullNot funbullNot on-task

                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                  Volkow et al 2004

                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                  Quarterly QI review

                                                                                                                                                                                                  The post-mortem

                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                  Yoga read

                                                                                                                                                                                                  Staff meeting

                                                                                                                                                                                                  Planningsession

                                                                                                                                                                                                  Phone calls

                                                                                                                                                                                                  billing

                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                  Learn French

                                                                                                                                                                                                  Stop smoking

                                                                                                                                                                                                  Be a better spouse

                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                                                  DavidNowell

                                                                                                                                                                                                  • Slide 1
                                                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                                                  • Slide 3
                                                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                  • Slide 7
                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                  • Overview
                                                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                  • Slide 17
                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                  • Slide 19
                                                                                                                                                                                                  • Strategies
                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                  • Slide 23
                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                  • Slide 25
                                                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                                                  • Slide 27
                                                                                                                                                                                                  • Slide 28
                                                                                                                                                                                                  • Slide 29
                                                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                  • Slide 35
                                                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                                                  • (C)APD
                                                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                                                  • Self-assessment
                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                  • Slide 42
                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                  • Core symptoms
                                                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                                                  • Slide 53
                                                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                                                  • Slide 63
                                                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                                                  • Slide 66
                                                                                                                                                                                                  • Slide 67
                                                                                                                                                                                                  • ADHD and women
                                                                                                                                                                                                  • Slide 69
                                                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                                                  • Slide 74
                                                                                                                                                                                                  • Slide 75
                                                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                  • Slide 84
                                                                                                                                                                                                  • Slide 85
                                                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                                                  • Slide 89
                                                                                                                                                                                                  • Slide 90
                                                                                                                                                                                                  • Slide 91
                                                                                                                                                                                                  • Slide 92
                                                                                                                                                                                                  • Slide 93
                                                                                                                                                                                                  • Slide 94
                                                                                                                                                                                                  • Slide 95
                                                                                                                                                                                                  • Slide 96
                                                                                                                                                                                                  • Slide 97
                                                                                                                                                                                                  • Slide 98
                                                                                                                                                                                                  • Slide 99
                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                  • Slide 101
                                                                                                                                                                                                  • Slide 102
                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                  • Slide 106
                                                                                                                                                                                                  • Slide 107
                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                  • Slide 109
                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                  • Time Out
                                                                                                                                                                                                  • Token economy
                                                                                                                                                                                                  • Slide 113
                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                  • Slide 115
                                                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                                                  • Slide 117
                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                  • Metacognition
                                                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                  • Slide 124
                                                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                  • Slide 128
                                                                                                                                                                                                  • Slide 129
                                                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                  • Slide 141
                                                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                  • Slide 146
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                  • Slide 149
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                  • Slide 152
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                  • Slide 154
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                  • Slide 157
                                                                                                                                                                                                  • Slide 158
                                                                                                                                                                                                  • Slide 159
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                  • Slide 162
                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                  • Slide 164
                                                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                                                  • Slide 166
                                                                                                                                                                                                  • Slide 167
                                                                                                                                                                                                  • Slide 168
                                                                                                                                                                                                  • Slide 169
                                                                                                                                                                                                  • Slide 170
                                                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                                                  • Match the Picture
                                                                                                                                                                                                  • Slide 176
                                                                                                                                                                                                  • Slide 177
                                                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                                                  • Slide 179
                                                                                                                                                                                                  • Slide 180
                                                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                                                  • Learning Time
                                                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                                                  • Slide 185
                                                                                                                                                                                                  • Slide 186
                                                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                                                  • Slide 189
                                                                                                                                                                                                  • Slide 190
                                                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                  • Slide 194
                                                                                                                                                                                                  • Slide 195
                                                                                                                                                                                                  • Slide 196
                                                                                                                                                                                                  • Slide 197
                                                                                                                                                                                                  • Slide 198
                                                                                                                                                                                                  • Slide 199
                                                                                                                                                                                                  • Slide 200
                                                                                                                                                                                                  • Slide 201
                                                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                                                  • The post-mortem
                                                                                                                                                                                                  • Slide 204
                                                                                                                                                                                                  • Slide 205
                                                                                                                                                                                                  • Slide 206
                                                                                                                                                                                                  • Slide 207
                                                                                                                                                                                                  • Slide 208
                                                                                                                                                                                                  • Slide 209
                                                                                                                                                                                                  • Slide 210
                                                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                                                  • Slide 212
                                                                                                                                                                                                  • Slide 213
                                                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                  • Slide 215
                                                                                                                                                                                                  • Slide 216
                                                                                                                                                                                                  • Slide 217
                                                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                  • A challengehellip
                                                                                                                                                                                                  • Slide 222

                                                                                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                                    ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                                    The reward-and-planning system

                                                                                                                                                                                                    Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                                    Lend Me Your Brain

                                                                                                                                                                                                    Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                    Too busy with current activity

                                                                                                                                                                                                    Field dependent

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Sequence problem-solve

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Block out distractions

                                                                                                                                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                    - E Goldberg

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Get the reward

                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                    Instant gratification vs

                                                                                                                                                                                                    executive gratification

                                                                                                                                                                                                    A B C

                                                                                                                                                                                                    behaviorx

                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                    takerdquordquo

                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                    thathelliprdquo

                                                                                                                                                                                                    Match the Picture

                                                                                                                                                                                                    Distraction Delay Training

                                                                                                                                                                                                    Executive Estimates Training

                                                                                                                                                                                                    X

                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                    Asking two questionshellip

                                                                                                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                    this

                                                                                                                                                                                                    what

                                                                                                                                                                                                    I se

                                                                                                                                                                                                    t out

                                                                                                                                                                                                    to

                                                                                                                                                                                                    do

                                                                                                                                                                                                    bullYesbullYes

                                                                                                                                                                                                    bullNobullYes

                                                                                                                                                                                                    bullYesbullNo

                                                                                                                                                                                                    bullNobullNo

                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                    this

                                                                                                                                                                                                    what

                                                                                                                                                                                                    I se

                                                                                                                                                                                                    t out

                                                                                                                                                                                                    to

                                                                                                                                                                                                    do

                                                                                                                                                                                                    bullFunbullOn-task

                                                                                                                                                                                                    bullNot funbullOn-task

                                                                                                                                                                                                    bullFunbullNot on-task

                                                                                                                                                                                                    bullNot funbullNot on-task

                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                    Volkow et al 2004

                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                    Quarterly QI review

                                                                                                                                                                                                    The post-mortem

                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                    Yoga read

                                                                                                                                                                                                    Staff meeting

                                                                                                                                                                                                    Planningsession

                                                                                                                                                                                                    Phone calls

                                                                                                                                                                                                    billing

                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                    Learn French

                                                                                                                                                                                                    Stop smoking

                                                                                                                                                                                                    Be a better spouse

                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                                                    DavidNowell

                                                                                                                                                                                                    • Slide 1
                                                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                                                    • Slide 3
                                                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                    • Slide 7
                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                    • Overview
                                                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                    • Slide 17
                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                    • Slide 19
                                                                                                                                                                                                    • Strategies
                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                    • Slide 23
                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                    • Slide 25
                                                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                                                    • Slide 27
                                                                                                                                                                                                    • Slide 28
                                                                                                                                                                                                    • Slide 29
                                                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                    • Slide 35
                                                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                                                    • (C)APD
                                                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                                                    • Self-assessment
                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                    • Slide 42
                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                    • Core symptoms
                                                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                                                    • Slide 53
                                                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                                                    • Slide 63
                                                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                                                    • Slide 66
                                                                                                                                                                                                    • Slide 67
                                                                                                                                                                                                    • ADHD and women
                                                                                                                                                                                                    • Slide 69
                                                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                                                    • Slide 74
                                                                                                                                                                                                    • Slide 75
                                                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                    • Slide 84
                                                                                                                                                                                                    • Slide 85
                                                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                                                    • Slide 89
                                                                                                                                                                                                    • Slide 90
                                                                                                                                                                                                    • Slide 91
                                                                                                                                                                                                    • Slide 92
                                                                                                                                                                                                    • Slide 93
                                                                                                                                                                                                    • Slide 94
                                                                                                                                                                                                    • Slide 95
                                                                                                                                                                                                    • Slide 96
                                                                                                                                                                                                    • Slide 97
                                                                                                                                                                                                    • Slide 98
                                                                                                                                                                                                    • Slide 99
                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                    • Slide 101
                                                                                                                                                                                                    • Slide 102
                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                    • Slide 106
                                                                                                                                                                                                    • Slide 107
                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                    • Slide 109
                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                    • Time Out
                                                                                                                                                                                                    • Token economy
                                                                                                                                                                                                    • Slide 113
                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                    • Slide 115
                                                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                                                    • Slide 117
                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                    • Metacognition
                                                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                    • Slide 124
                                                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                    • Slide 128
                                                                                                                                                                                                    • Slide 129
                                                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                    • Slide 141
                                                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                    • Slide 146
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                    • Slide 149
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                    • Slide 152
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                    • Slide 154
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                    • Slide 157
                                                                                                                                                                                                    • Slide 158
                                                                                                                                                                                                    • Slide 159
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                    • Slide 162
                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                    • Slide 164
                                                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                                                    • Slide 166
                                                                                                                                                                                                    • Slide 167
                                                                                                                                                                                                    • Slide 168
                                                                                                                                                                                                    • Slide 169
                                                                                                                                                                                                    • Slide 170
                                                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                                                    • Match the Picture
                                                                                                                                                                                                    • Slide 176
                                                                                                                                                                                                    • Slide 177
                                                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                                                    • Slide 179
                                                                                                                                                                                                    • Slide 180
                                                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                                                    • Learning Time
                                                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                                                    • Slide 185
                                                                                                                                                                                                    • Slide 186
                                                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                                                    • Slide 189
                                                                                                                                                                                                    • Slide 190
                                                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                    • Slide 194
                                                                                                                                                                                                    • Slide 195
                                                                                                                                                                                                    • Slide 196
                                                                                                                                                                                                    • Slide 197
                                                                                                                                                                                                    • Slide 198
                                                                                                                                                                                                    • Slide 199
                                                                                                                                                                                                    • Slide 200
                                                                                                                                                                                                    • Slide 201
                                                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                                                    • The post-mortem
                                                                                                                                                                                                    • Slide 204
                                                                                                                                                                                                    • Slide 205
                                                                                                                                                                                                    • Slide 206
                                                                                                                                                                                                    • Slide 207
                                                                                                                                                                                                    • Slide 208
                                                                                                                                                                                                    • Slide 209
                                                                                                                                                                                                    • Slide 210
                                                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                                                    • Slide 212
                                                                                                                                                                                                    • Slide 213
                                                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                    • Slide 215
                                                                                                                                                                                                    • Slide 216
                                                                                                                                                                                                    • Slide 217
                                                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                    • A challengehellip
                                                                                                                                                                                                    • Slide 222

                                                                                                                                                                                                      ldquowhat isrdquo vs ldquowhat could berdquo

                                                                                                                                                                                                      The reward-and-planning system

                                                                                                                                                                                                      Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                                      Lend Me Your Brain

                                                                                                                                                                                                      Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                      Too busy with current activity

                                                                                                                                                                                                      Field dependent

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Sequence problem-solve

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Block out distractions

                                                                                                                                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                      - E Goldberg

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Get the reward

                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                      Instant gratification vs

                                                                                                                                                                                                      executive gratification

                                                                                                                                                                                                      A B C

                                                                                                                                                                                                      behaviorx

                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                      takerdquordquo

                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                      thathelliprdquo

                                                                                                                                                                                                      Match the Picture

                                                                                                                                                                                                      Distraction Delay Training

                                                                                                                                                                                                      Executive Estimates Training

                                                                                                                                                                                                      X

                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                      Asking two questionshellip

                                                                                                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                      this

                                                                                                                                                                                                      what

                                                                                                                                                                                                      I se

                                                                                                                                                                                                      t out

                                                                                                                                                                                                      to

                                                                                                                                                                                                      do

                                                                                                                                                                                                      bullYesbullYes

                                                                                                                                                                                                      bullNobullYes

                                                                                                                                                                                                      bullYesbullNo

                                                                                                                                                                                                      bullNobullNo

                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                      this

                                                                                                                                                                                                      what

                                                                                                                                                                                                      I se

                                                                                                                                                                                                      t out

                                                                                                                                                                                                      to

                                                                                                                                                                                                      do

                                                                                                                                                                                                      bullFunbullOn-task

                                                                                                                                                                                                      bullNot funbullOn-task

                                                                                                                                                                                                      bullFunbullNot on-task

                                                                                                                                                                                                      bullNot funbullNot on-task

                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                      Volkow et al 2004

                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                      Quarterly QI review

                                                                                                                                                                                                      The post-mortem

                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                      Yoga read

                                                                                                                                                                                                      Staff meeting

                                                                                                                                                                                                      Planningsession

                                                                                                                                                                                                      Phone calls

                                                                                                                                                                                                      billing

                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                      Learn French

                                                                                                                                                                                                      Stop smoking

                                                                                                                                                                                                      Be a better spouse

                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                                                                      DavidNowell

                                                                                                                                                                                                      • Slide 1
                                                                                                                                                                                                      • hellipa challenge
                                                                                                                                                                                                      • Slide 3
                                                                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                      • Slide 7
                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                      • Overview
                                                                                                                                                                                                      • This Dense Pudding
                                                                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                                      • Developmental considerations
                                                                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                      • Slide 17
                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                      • Slide 19
                                                                                                                                                                                                      • Strategies
                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                                      • Slide 23
                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                      • Slide 25
                                                                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                                                                      • Slide 27
                                                                                                                                                                                                      • Slide 28
                                                                                                                                                                                                      • Slide 29
                                                                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                      • Slide 35
                                                                                                                                                                                                      • Strategies (2)
                                                                                                                                                                                                      • (C)APD
                                                                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                                                                      • Self-assessment
                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                      • Slide 42
                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                      • Core symptoms
                                                                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                                                                      • Slide 53
                                                                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                                                                      • Slide 63
                                                                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                                                                      • ADHD and girls
                                                                                                                                                                                                      • Slide 66
                                                                                                                                                                                                      • Slide 67
                                                                                                                                                                                                      • ADHD and women
                                                                                                                                                                                                      • Slide 69
                                                                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                                                                      • The Executive Functions
                                                                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                                                                      • Slide 74
                                                                                                                                                                                                      • Slide 75
                                                                                                                                                                                                      • Appropriate expectations
                                                                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                      • Slide 84
                                                                                                                                                                                                      • Slide 85
                                                                                                                                                                                                      • Strategies (3)
                                                                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                                                                      • Behavioral Supports
                                                                                                                                                                                                      • Slide 89
                                                                                                                                                                                                      • Slide 90
                                                                                                                                                                                                      • Slide 91
                                                                                                                                                                                                      • Slide 92
                                                                                                                                                                                                      • Slide 93
                                                                                                                                                                                                      • Slide 94
                                                                                                                                                                                                      • Slide 95
                                                                                                                                                                                                      • Slide 96
                                                                                                                                                                                                      • Slide 97
                                                                                                                                                                                                      • Slide 98
                                                                                                                                                                                                      • Slide 99
                                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                                      • Slide 101
                                                                                                                                                                                                      • Slide 102
                                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                                      • Slide 106
                                                                                                                                                                                                      • Slide 107
                                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                                      • Slide 109
                                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                                      • Time Out
                                                                                                                                                                                                      • Token economy
                                                                                                                                                                                                      • Slide 113
                                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                                      • Slide 115
                                                                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                                                                      • Slide 117
                                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                                      • Metacognition
                                                                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                      • Slide 124
                                                                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                      • Slide 128
                                                                                                                                                                                                      • Slide 129
                                                                                                                                                                                                      • Broaden and Build
                                                                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                      • Slide 141
                                                                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                      • Slide 146
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                      • Slide 149
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                      • Slide 152
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                      • Slide 154
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                      • Slide 157
                                                                                                                                                                                                      • Slide 158
                                                                                                                                                                                                      • Slide 159
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                      • Slide 162
                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                      • Slide 164
                                                                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                                                                      • Slide 166
                                                                                                                                                                                                      • Slide 167
                                                                                                                                                                                                      • Slide 168
                                                                                                                                                                                                      • Slide 169
                                                                                                                                                                                                      • Slide 170
                                                                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                                                                      • Match the Picture
                                                                                                                                                                                                      • Slide 176
                                                                                                                                                                                                      • Slide 177
                                                                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                                                                      • Slide 179
                                                                                                                                                                                                      • Slide 180
                                                                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                                                                      • Learning Time
                                                                                                                                                                                                      • Learning Time (2)
                                                                                                                                                                                                      • Learning Time (3)
                                                                                                                                                                                                      • Slide 185
                                                                                                                                                                                                      • Slide 186
                                                                                                                                                                                                      • Learning Time (4)
                                                                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                                                                      • Slide 189
                                                                                                                                                                                                      • Slide 190
                                                                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                      • Slide 194
                                                                                                                                                                                                      • Slide 195
                                                                                                                                                                                                      • Slide 196
                                                                                                                                                                                                      • Slide 197
                                                                                                                                                                                                      • Slide 198
                                                                                                                                                                                                      • Slide 199
                                                                                                                                                                                                      • Slide 200
                                                                                                                                                                                                      • Slide 201
                                                                                                                                                                                                      • Quarterly QI review
                                                                                                                                                                                                      • The post-mortem
                                                                                                                                                                                                      • Slide 204
                                                                                                                                                                                                      • Slide 205
                                                                                                                                                                                                      • Slide 206
                                                                                                                                                                                                      • Slide 207
                                                                                                                                                                                                      • Slide 208
                                                                                                                                                                                                      • Slide 209
                                                                                                                                                                                                      • Slide 210
                                                                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                                                                      • Slide 212
                                                                                                                                                                                                      • Slide 213
                                                                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                      • Slide 215
                                                                                                                                                                                                      • Slide 216
                                                                                                                                                                                                      • Slide 217
                                                                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                      • A challengehellip
                                                                                                                                                                                                      • Slide 222

                                                                                                                                                                                                        The reward-and-planning system

                                                                                                                                                                                                        Anticipate goal Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                                        Lend Me Your Brain

                                                                                                                                                                                                        Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                        Too busy with current activity

                                                                                                                                                                                                        Field dependent

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Sequence problem-solve

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Block out distractions

                                                                                                                                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                        - E Goldberg

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Get the reward

                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                        Instant gratification vs

                                                                                                                                                                                                        executive gratification

                                                                                                                                                                                                        A B C

                                                                                                                                                                                                        behaviorx

                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                        takerdquordquo

                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                        thathelliprdquo

                                                                                                                                                                                                        Match the Picture

                                                                                                                                                                                                        Distraction Delay Training

                                                                                                                                                                                                        Executive Estimates Training

                                                                                                                                                                                                        X

                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                        Asking two questionshellip

                                                                                                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                        this

                                                                                                                                                                                                        what

                                                                                                                                                                                                        I se

                                                                                                                                                                                                        t out

                                                                                                                                                                                                        to

                                                                                                                                                                                                        do

                                                                                                                                                                                                        bullYesbullYes

                                                                                                                                                                                                        bullNobullYes

                                                                                                                                                                                                        bullYesbullNo

                                                                                                                                                                                                        bullNobullNo

                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                        this

                                                                                                                                                                                                        what

                                                                                                                                                                                                        I se

                                                                                                                                                                                                        t out

                                                                                                                                                                                                        to

                                                                                                                                                                                                        do

                                                                                                                                                                                                        bullFunbullOn-task

                                                                                                                                                                                                        bullNot funbullOn-task

                                                                                                                                                                                                        bullFunbullNot on-task

                                                                                                                                                                                                        bullNot funbullNot on-task

                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                        Volkow et al 2004

                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                        Quarterly QI review

                                                                                                                                                                                                        The post-mortem

                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                        Yoga read

                                                                                                                                                                                                        Staff meeting

                                                                                                                                                                                                        Planningsession

                                                                                                                                                                                                        Phone calls

                                                                                                                                                                                                        billing

                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                        Learn French

                                                                                                                                                                                                        Stop smoking

                                                                                                                                                                                                        Be a better spouse

                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                                                                        DavidNowell

                                                                                                                                                                                                        • Slide 1
                                                                                                                                                                                                        • hellipa challenge
                                                                                                                                                                                                        • Slide 3
                                                                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                        • Slide 7
                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                        • Overview
                                                                                                                                                                                                        • This Dense Pudding
                                                                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                                        • Developmental considerations
                                                                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                        • Slide 17
                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                        • Slide 19
                                                                                                                                                                                                        • Strategies
                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                                        • Slide 23
                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                        • Slide 25
                                                                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                                                                        • Slide 27
                                                                                                                                                                                                        • Slide 28
                                                                                                                                                                                                        • Slide 29
                                                                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                        • Slide 35
                                                                                                                                                                                                        • Strategies (2)
                                                                                                                                                                                                        • (C)APD
                                                                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                                                                        • Self-assessment
                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                        • Slide 42
                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                        • Core symptoms
                                                                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                                                                        • Slide 53
                                                                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                                                                        • Slide 63
                                                                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                                                                        • ADHD and girls
                                                                                                                                                                                                        • Slide 66
                                                                                                                                                                                                        • Slide 67
                                                                                                                                                                                                        • ADHD and women
                                                                                                                                                                                                        • Slide 69
                                                                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                                                                        • The Executive Functions
                                                                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                                                                        • Slide 74
                                                                                                                                                                                                        • Slide 75
                                                                                                                                                                                                        • Appropriate expectations
                                                                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                        • Slide 84
                                                                                                                                                                                                        • Slide 85
                                                                                                                                                                                                        • Strategies (3)
                                                                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                                                                        • Behavioral Supports
                                                                                                                                                                                                        • Slide 89
                                                                                                                                                                                                        • Slide 90
                                                                                                                                                                                                        • Slide 91
                                                                                                                                                                                                        • Slide 92
                                                                                                                                                                                                        • Slide 93
                                                                                                                                                                                                        • Slide 94
                                                                                                                                                                                                        • Slide 95
                                                                                                                                                                                                        • Slide 96
                                                                                                                                                                                                        • Slide 97
                                                                                                                                                                                                        • Slide 98
                                                                                                                                                                                                        • Slide 99
                                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                                        • Slide 101
                                                                                                                                                                                                        • Slide 102
                                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                                        • Slide 106
                                                                                                                                                                                                        • Slide 107
                                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                                        • Slide 109
                                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                                        • Time Out
                                                                                                                                                                                                        • Token economy
                                                                                                                                                                                                        • Slide 113
                                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                                        • Slide 115
                                                                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                                                                        • Slide 117
                                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                                        • Metacognition
                                                                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                        • Slide 124
                                                                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                        • Slide 128
                                                                                                                                                                                                        • Slide 129
                                                                                                                                                                                                        • Broaden and Build
                                                                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                        • Slide 141
                                                                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                        • Slide 146
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                        • Slide 149
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                        • Slide 152
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                        • Slide 154
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                        • Slide 157
                                                                                                                                                                                                        • Slide 158
                                                                                                                                                                                                        • Slide 159
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                        • Slide 162
                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                        • Slide 164
                                                                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                                                                        • Slide 166
                                                                                                                                                                                                        • Slide 167
                                                                                                                                                                                                        • Slide 168
                                                                                                                                                                                                        • Slide 169
                                                                                                                                                                                                        • Slide 170
                                                                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                                                                        • Match the Picture
                                                                                                                                                                                                        • Slide 176
                                                                                                                                                                                                        • Slide 177
                                                                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                                                                        • Slide 179
                                                                                                                                                                                                        • Slide 180
                                                                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                                                                        • Learning Time
                                                                                                                                                                                                        • Learning Time (2)
                                                                                                                                                                                                        • Learning Time (3)
                                                                                                                                                                                                        • Slide 185
                                                                                                                                                                                                        • Slide 186
                                                                                                                                                                                                        • Learning Time (4)
                                                                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                                                                        • Slide 189
                                                                                                                                                                                                        • Slide 190
                                                                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                        • Slide 194
                                                                                                                                                                                                        • Slide 195
                                                                                                                                                                                                        • Slide 196
                                                                                                                                                                                                        • Slide 197
                                                                                                                                                                                                        • Slide 198
                                                                                                                                                                                                        • Slide 199
                                                                                                                                                                                                        • Slide 200
                                                                                                                                                                                                        • Slide 201
                                                                                                                                                                                                        • Quarterly QI review
                                                                                                                                                                                                        • The post-mortem
                                                                                                                                                                                                        • Slide 204
                                                                                                                                                                                                        • Slide 205
                                                                                                                                                                                                        • Slide 206
                                                                                                                                                                                                        • Slide 207
                                                                                                                                                                                                        • Slide 208
                                                                                                                                                                                                        • Slide 209
                                                                                                                                                                                                        • Slide 210
                                                                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                                                                        • Slide 212
                                                                                                                                                                                                        • Slide 213
                                                                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                        • Slide 215
                                                                                                                                                                                                        • Slide 216
                                                                                                                                                                                                        • Slide 217
                                                                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                        • A challengehellip
                                                                                                                                                                                                        • Slide 222

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Alicia R Ruelaz MD ldquothe biggest issue for me and others Ive seen has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completedrdquo

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                                          Lend Me Your Brain

                                                                                                                                                                                                          Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                          Too busy with current activity

                                                                                                                                                                                                          Field dependent

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Sequence problem-solve

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Block out distractions

                                                                                                                                                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                          - E Goldberg

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Get the reward

                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                          Instant gratification vs

                                                                                                                                                                                                          executive gratification

                                                                                                                                                                                                          A B C

                                                                                                                                                                                                          behaviorx

                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                          takerdquordquo

                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                          thathelliprdquo

                                                                                                                                                                                                          Match the Picture

                                                                                                                                                                                                          Distraction Delay Training

                                                                                                                                                                                                          Executive Estimates Training

                                                                                                                                                                                                          X

                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                          Asking two questionshellip

                                                                                                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                          this

                                                                                                                                                                                                          what

                                                                                                                                                                                                          I se

                                                                                                                                                                                                          t out

                                                                                                                                                                                                          to

                                                                                                                                                                                                          do

                                                                                                                                                                                                          bullYesbullYes

                                                                                                                                                                                                          bullNobullYes

                                                                                                                                                                                                          bullYesbullNo

                                                                                                                                                                                                          bullNobullNo

                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                          this

                                                                                                                                                                                                          what

                                                                                                                                                                                                          I se

                                                                                                                                                                                                          t out

                                                                                                                                                                                                          to

                                                                                                                                                                                                          do

                                                                                                                                                                                                          bullFunbullOn-task

                                                                                                                                                                                                          bullNot funbullOn-task

                                                                                                                                                                                                          bullFunbullNot on-task

                                                                                                                                                                                                          bullNot funbullNot on-task

                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                          Volkow et al 2004

                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                          Quarterly QI review

                                                                                                                                                                                                          The post-mortem

                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                          Yoga read

                                                                                                                                                                                                          Staff meeting

                                                                                                                                                                                                          Planningsession

                                                                                                                                                                                                          Phone calls

                                                                                                                                                                                                          billing

                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                          Learn French

                                                                                                                                                                                                          Stop smoking

                                                                                                                                                                                                          Be a better spouse

                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                                                                          DavidNowell

                                                                                                                                                                                                          • Slide 1
                                                                                                                                                                                                          • hellipa challenge
                                                                                                                                                                                                          • Slide 3
                                                                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                          • Slide 7
                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                          • Overview
                                                                                                                                                                                                          • This Dense Pudding
                                                                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                                          • Developmental considerations
                                                                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                          • Slide 17
                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                          • Slide 19
                                                                                                                                                                                                          • Strategies
                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                                          • Slide 23
                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                          • Slide 25
                                                                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                                                                          • Slide 27
                                                                                                                                                                                                          • Slide 28
                                                                                                                                                                                                          • Slide 29
                                                                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                          • Slide 35
                                                                                                                                                                                                          • Strategies (2)
                                                                                                                                                                                                          • (C)APD
                                                                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                                                                          • Self-assessment
                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                          • Slide 42
                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                          • Core symptoms
                                                                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                                                                          • Slide 53
                                                                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                                                                          • Slide 63
                                                                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                                                                          • ADHD and girls
                                                                                                                                                                                                          • Slide 66
                                                                                                                                                                                                          • Slide 67
                                                                                                                                                                                                          • ADHD and women
                                                                                                                                                                                                          • Slide 69
                                                                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                                                                          • The Executive Functions
                                                                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                                                                          • Slide 74
                                                                                                                                                                                                          • Slide 75
                                                                                                                                                                                                          • Appropriate expectations
                                                                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                          • Slide 84
                                                                                                                                                                                                          • Slide 85
                                                                                                                                                                                                          • Strategies (3)
                                                                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                                                                          • Behavioral Supports
                                                                                                                                                                                                          • Slide 89
                                                                                                                                                                                                          • Slide 90
                                                                                                                                                                                                          • Slide 91
                                                                                                                                                                                                          • Slide 92
                                                                                                                                                                                                          • Slide 93
                                                                                                                                                                                                          • Slide 94
                                                                                                                                                                                                          • Slide 95
                                                                                                                                                                                                          • Slide 96
                                                                                                                                                                                                          • Slide 97
                                                                                                                                                                                                          • Slide 98
                                                                                                                                                                                                          • Slide 99
                                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                                          • Slide 101
                                                                                                                                                                                                          • Slide 102
                                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                                          • Slide 106
                                                                                                                                                                                                          • Slide 107
                                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                                          • Slide 109
                                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                                          • Time Out
                                                                                                                                                                                                          • Token economy
                                                                                                                                                                                                          • Slide 113
                                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                                          • Slide 115
                                                                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                                                                          • Slide 117
                                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                                          • Metacognition
                                                                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                          • Slide 124
                                                                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                          • Slide 128
                                                                                                                                                                                                          • Slide 129
                                                                                                                                                                                                          • Broaden and Build
                                                                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                          • Slide 141
                                                                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                          • Slide 146
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                          • Slide 149
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                          • Slide 152
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                          • Slide 154
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                          • Slide 157
                                                                                                                                                                                                          • Slide 158
                                                                                                                                                                                                          • Slide 159
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                          • Slide 162
                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                          • Slide 164
                                                                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                                                                          • Slide 166
                                                                                                                                                                                                          • Slide 167
                                                                                                                                                                                                          • Slide 168
                                                                                                                                                                                                          • Slide 169
                                                                                                                                                                                                          • Slide 170
                                                                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                                                                          • Match the Picture
                                                                                                                                                                                                          • Slide 176
                                                                                                                                                                                                          • Slide 177
                                                                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                                                                          • Slide 179
                                                                                                                                                                                                          • Slide 180
                                                                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                                                                          • Learning Time
                                                                                                                                                                                                          • Learning Time (2)
                                                                                                                                                                                                          • Learning Time (3)
                                                                                                                                                                                                          • Slide 185
                                                                                                                                                                                                          • Slide 186
                                                                                                                                                                                                          • Learning Time (4)
                                                                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                                                                          • Slide 189
                                                                                                                                                                                                          • Slide 190
                                                                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                          • Slide 194
                                                                                                                                                                                                          • Slide 195
                                                                                                                                                                                                          • Slide 196
                                                                                                                                                                                                          • Slide 197
                                                                                                                                                                                                          • Slide 198
                                                                                                                                                                                                          • Slide 199
                                                                                                                                                                                                          • Slide 200
                                                                                                                                                                                                          • Slide 201
                                                                                                                                                                                                          • Quarterly QI review
                                                                                                                                                                                                          • The post-mortem
                                                                                                                                                                                                          • Slide 204
                                                                                                                                                                                                          • Slide 205
                                                                                                                                                                                                          • Slide 206
                                                                                                                                                                                                          • Slide 207
                                                                                                                                                                                                          • Slide 208
                                                                                                                                                                                                          • Slide 209
                                                                                                                                                                                                          • Slide 210
                                                                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                                                                          • Slide 212
                                                                                                                                                                                                          • Slide 213
                                                                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                          • Slide 215
                                                                                                                                                                                                          • Slide 216
                                                                                                                                                                                                          • Slide 217
                                                                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                          • A challengehellip
                                                                                                                                                                                                          • Slide 222

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Jacy a freelance artist from Connecticut I get so excited about a new idea I forget the zeal that I had once felt for an old one Thus creating my inevitable idea graveyardldquo

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                                            Lend Me Your Brain

                                                                                                                                                                                                            Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                            Too busy with current activity

                                                                                                                                                                                                            Field dependent

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Sequence problem-solve

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Block out distractions

                                                                                                                                                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                            - E Goldberg

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Get the reward

                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                            Instant gratification vs

                                                                                                                                                                                                            executive gratification

                                                                                                                                                                                                            A B C

                                                                                                                                                                                                            behaviorx

                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                            takerdquordquo

                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                            thathelliprdquo

                                                                                                                                                                                                            Match the Picture

                                                                                                                                                                                                            Distraction Delay Training

                                                                                                                                                                                                            Executive Estimates Training

                                                                                                                                                                                                            X

                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                            Asking two questionshellip

                                                                                                                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                            this

                                                                                                                                                                                                            what

                                                                                                                                                                                                            I se

                                                                                                                                                                                                            t out

                                                                                                                                                                                                            to

                                                                                                                                                                                                            do

                                                                                                                                                                                                            bullYesbullYes

                                                                                                                                                                                                            bullNobullYes

                                                                                                                                                                                                            bullYesbullNo

                                                                                                                                                                                                            bullNobullNo

                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                            this

                                                                                                                                                                                                            what

                                                                                                                                                                                                            I se

                                                                                                                                                                                                            t out

                                                                                                                                                                                                            to

                                                                                                                                                                                                            do

                                                                                                                                                                                                            bullFunbullOn-task

                                                                                                                                                                                                            bullNot funbullOn-task

                                                                                                                                                                                                            bullFunbullNot on-task

                                                                                                                                                                                                            bullNot funbullNot on-task

                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                            Volkow et al 2004

                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                            Quarterly QI review

                                                                                                                                                                                                            The post-mortem

                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                            Yoga read

                                                                                                                                                                                                            Staff meeting

                                                                                                                                                                                                            Planningsession

                                                                                                                                                                                                            Phone calls

                                                                                                                                                                                                            billing

                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                            Learn French

                                                                                                                                                                                                            Stop smoking

                                                                                                                                                                                                            Be a better spouse

                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                                                                            DavidNowell

                                                                                                                                                                                                            • Slide 1
                                                                                                                                                                                                            • hellipa challenge
                                                                                                                                                                                                            • Slide 3
                                                                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                            • Slide 7
                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                            • Overview
                                                                                                                                                                                                            • This Dense Pudding
                                                                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                                            • Developmental considerations
                                                                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                            • Slide 17
                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                            • Slide 19
                                                                                                                                                                                                            • Strategies
                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                                            • Slide 23
                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                            • Slide 25
                                                                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                                                                            • Slide 27
                                                                                                                                                                                                            • Slide 28
                                                                                                                                                                                                            • Slide 29
                                                                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                            • Slide 35
                                                                                                                                                                                                            • Strategies (2)
                                                                                                                                                                                                            • (C)APD
                                                                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                                                                            • Self-assessment
                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                            • Slide 42
                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                            • Core symptoms
                                                                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                                                                            • Slide 53
                                                                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                                                                            • Slide 63
                                                                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                                                                            • ADHD and girls
                                                                                                                                                                                                            • Slide 66
                                                                                                                                                                                                            • Slide 67
                                                                                                                                                                                                            • ADHD and women
                                                                                                                                                                                                            • Slide 69
                                                                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                                                                            • The Executive Functions
                                                                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                                                                            • Slide 74
                                                                                                                                                                                                            • Slide 75
                                                                                                                                                                                                            • Appropriate expectations
                                                                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                            • Slide 84
                                                                                                                                                                                                            • Slide 85
                                                                                                                                                                                                            • Strategies (3)
                                                                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                                                                            • Behavioral Supports
                                                                                                                                                                                                            • Slide 89
                                                                                                                                                                                                            • Slide 90
                                                                                                                                                                                                            • Slide 91
                                                                                                                                                                                                            • Slide 92
                                                                                                                                                                                                            • Slide 93
                                                                                                                                                                                                            • Slide 94
                                                                                                                                                                                                            • Slide 95
                                                                                                                                                                                                            • Slide 96
                                                                                                                                                                                                            • Slide 97
                                                                                                                                                                                                            • Slide 98
                                                                                                                                                                                                            • Slide 99
                                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                                            • Slide 101
                                                                                                                                                                                                            • Slide 102
                                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                                            • Slide 106
                                                                                                                                                                                                            • Slide 107
                                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                                            • Slide 109
                                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                                            • Time Out
                                                                                                                                                                                                            • Token economy
                                                                                                                                                                                                            • Slide 113
                                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                                            • Slide 115
                                                                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                                                                            • Slide 117
                                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                                            • Metacognition
                                                                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                            • Slide 124
                                                                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                            • Slide 128
                                                                                                                                                                                                            • Slide 129
                                                                                                                                                                                                            • Broaden and Build
                                                                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                            • Slide 141
                                                                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                            • Slide 146
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                            • Slide 149
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                            • Slide 152
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                            • Slide 154
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                            • Slide 157
                                                                                                                                                                                                            • Slide 158
                                                                                                                                                                                                            • Slide 159
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                            • Slide 162
                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                            • Slide 164
                                                                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                                                                            • Slide 166
                                                                                                                                                                                                            • Slide 167
                                                                                                                                                                                                            • Slide 168
                                                                                                                                                                                                            • Slide 169
                                                                                                                                                                                                            • Slide 170
                                                                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                                                                            • Match the Picture
                                                                                                                                                                                                            • Slide 176
                                                                                                                                                                                                            • Slide 177
                                                                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                                                                            • Slide 179
                                                                                                                                                                                                            • Slide 180
                                                                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                                                                            • Learning Time
                                                                                                                                                                                                            • Learning Time (2)
                                                                                                                                                                                                            • Learning Time (3)
                                                                                                                                                                                                            • Slide 185
                                                                                                                                                                                                            • Slide 186
                                                                                                                                                                                                            • Learning Time (4)
                                                                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                                                                            • Slide 189
                                                                                                                                                                                                            • Slide 190
                                                                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                            • Slide 194
                                                                                                                                                                                                            • Slide 195
                                                                                                                                                                                                            • Slide 196
                                                                                                                                                                                                            • Slide 197
                                                                                                                                                                                                            • Slide 198
                                                                                                                                                                                                            • Slide 199
                                                                                                                                                                                                            • Slide 200
                                                                                                                                                                                                            • Slide 201
                                                                                                                                                                                                            • Quarterly QI review
                                                                                                                                                                                                            • The post-mortem
                                                                                                                                                                                                            • Slide 204
                                                                                                                                                                                                            • Slide 205
                                                                                                                                                                                                            • Slide 206
                                                                                                                                                                                                            • Slide 207
                                                                                                                                                                                                            • Slide 208
                                                                                                                                                                                                            • Slide 209
                                                                                                                                                                                                            • Slide 210
                                                                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                                                                            • Slide 212
                                                                                                                                                                                                            • Slide 213
                                                                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                            • Slide 215
                                                                                                                                                                                                            • Slide 216
                                                                                                                                                                                                            • Slide 217
                                                                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                            • A challengehellip
                                                                                                                                                                                                            • Slide 222

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Juzer ldquomy biggest problem is that I want to do everything all at oncerdquo

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                                              Lend Me Your Brain

                                                                                                                                                                                                              Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                              Too busy with current activity

                                                                                                                                                                                                              Field dependent

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Sequence problem-solve

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Block out distractions

                                                                                                                                                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                              - E Goldberg

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Get the reward

                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                              Instant gratification vs

                                                                                                                                                                                                              executive gratification

                                                                                                                                                                                                              A B C

                                                                                                                                                                                                              behaviorx

                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                              takerdquordquo

                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                              thathelliprdquo

                                                                                                                                                                                                              Match the Picture

                                                                                                                                                                                                              Distraction Delay Training

                                                                                                                                                                                                              Executive Estimates Training

                                                                                                                                                                                                              X

                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                              Asking two questionshellip

                                                                                                                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                                              this

                                                                                                                                                                                                              what

                                                                                                                                                                                                              I se

                                                                                                                                                                                                              t out

                                                                                                                                                                                                              to

                                                                                                                                                                                                              do

                                                                                                                                                                                                              bullYesbullYes

                                                                                                                                                                                                              bullNobullYes

                                                                                                                                                                                                              bullYesbullNo

                                                                                                                                                                                                              bullNobullNo

                                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                                              this

                                                                                                                                                                                                              what

                                                                                                                                                                                                              I se

                                                                                                                                                                                                              t out

                                                                                                                                                                                                              to

                                                                                                                                                                                                              do

                                                                                                                                                                                                              bullFunbullOn-task

                                                                                                                                                                                                              bullNot funbullOn-task

                                                                                                                                                                                                              bullFunbullNot on-task

                                                                                                                                                                                                              bullNot funbullNot on-task

                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                              Volkow et al 2004

                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                              Quarterly QI review

                                                                                                                                                                                                              The post-mortem

                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                              Yoga read

                                                                                                                                                                                                              Staff meeting

                                                                                                                                                                                                              Planningsession

                                                                                                                                                                                                              Phone calls

                                                                                                                                                                                                              billing

                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                              Learn French

                                                                                                                                                                                                              Stop smoking

                                                                                                                                                                                                              Be a better spouse

                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                                                                              DavidNowell

                                                                                                                                                                                                              • Slide 1
                                                                                                                                                                                                              • hellipa challenge
                                                                                                                                                                                                              • Slide 3
                                                                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                              • Slide 7
                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                              • Overview
                                                                                                                                                                                                              • This Dense Pudding
                                                                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                                              • Developmental considerations
                                                                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                              • Slide 17
                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                              • Slide 19
                                                                                                                                                                                                              • Strategies
                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                                              • Slide 23
                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                              • Slide 25
                                                                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                                                                              • Slide 27
                                                                                                                                                                                                              • Slide 28
                                                                                                                                                                                                              • Slide 29
                                                                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                              • Slide 35
                                                                                                                                                                                                              • Strategies (2)
                                                                                                                                                                                                              • (C)APD
                                                                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                                                                              • Self-assessment
                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                              • Slide 42
                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                              • Core symptoms
                                                                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                                                                              • Slide 53
                                                                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                                                                              • Slide 63
                                                                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                                                                              • ADHD and girls
                                                                                                                                                                                                              • Slide 66
                                                                                                                                                                                                              • Slide 67
                                                                                                                                                                                                              • ADHD and women
                                                                                                                                                                                                              • Slide 69
                                                                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                                                                              • The Executive Functions
                                                                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                                                                              • Slide 74
                                                                                                                                                                                                              • Slide 75
                                                                                                                                                                                                              • Appropriate expectations
                                                                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                              • Slide 84
                                                                                                                                                                                                              • Slide 85
                                                                                                                                                                                                              • Strategies (3)
                                                                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                                                                              • Behavioral Supports
                                                                                                                                                                                                              • Slide 89
                                                                                                                                                                                                              • Slide 90
                                                                                                                                                                                                              • Slide 91
                                                                                                                                                                                                              • Slide 92
                                                                                                                                                                                                              • Slide 93
                                                                                                                                                                                                              • Slide 94
                                                                                                                                                                                                              • Slide 95
                                                                                                                                                                                                              • Slide 96
                                                                                                                                                                                                              • Slide 97
                                                                                                                                                                                                              • Slide 98
                                                                                                                                                                                                              • Slide 99
                                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                                              • Slide 101
                                                                                                                                                                                                              • Slide 102
                                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                                              • Slide 106
                                                                                                                                                                                                              • Slide 107
                                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                                              • Slide 109
                                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                                              • Time Out
                                                                                                                                                                                                              • Token economy
                                                                                                                                                                                                              • Slide 113
                                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                                              • Slide 115
                                                                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                                                                              • Slide 117
                                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                                              • Metacognition
                                                                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                              • Slide 124
                                                                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                              • Slide 128
                                                                                                                                                                                                              • Slide 129
                                                                                                                                                                                                              • Broaden and Build
                                                                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                              • Slide 141
                                                                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                              • Slide 146
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                              • Slide 149
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                              • Slide 152
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                              • Slide 154
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                              • Slide 157
                                                                                                                                                                                                              • Slide 158
                                                                                                                                                                                                              • Slide 159
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                              • Slide 162
                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                              • Slide 164
                                                                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                                                                              • Slide 166
                                                                                                                                                                                                              • Slide 167
                                                                                                                                                                                                              • Slide 168
                                                                                                                                                                                                              • Slide 169
                                                                                                                                                                                                              • Slide 170
                                                                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                                                                              • Match the Picture
                                                                                                                                                                                                              • Slide 176
                                                                                                                                                                                                              • Slide 177
                                                                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                                                                              • Slide 179
                                                                                                                                                                                                              • Slide 180
                                                                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                                                                              • Learning Time
                                                                                                                                                                                                              • Learning Time (2)
                                                                                                                                                                                                              • Learning Time (3)
                                                                                                                                                                                                              • Slide 185
                                                                                                                                                                                                              • Slide 186
                                                                                                                                                                                                              • Learning Time (4)
                                                                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                                                                              • Slide 189
                                                                                                                                                                                                              • Slide 190
                                                                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                              • Slide 194
                                                                                                                                                                                                              • Slide 195
                                                                                                                                                                                                              • Slide 196
                                                                                                                                                                                                              • Slide 197
                                                                                                                                                                                                              • Slide 198
                                                                                                                                                                                                              • Slide 199
                                                                                                                                                                                                              • Slide 200
                                                                                                                                                                                                              • Slide 201
                                                                                                                                                                                                              • Quarterly QI review
                                                                                                                                                                                                              • The post-mortem
                                                                                                                                                                                                              • Slide 204
                                                                                                                                                                                                              • Slide 205
                                                                                                                                                                                                              • Slide 206
                                                                                                                                                                                                              • Slide 207
                                                                                                                                                                                                              • Slide 208
                                                                                                                                                                                                              • Slide 209
                                                                                                                                                                                                              • Slide 210
                                                                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                                                                              • Slide 212
                                                                                                                                                                                                              • Slide 213
                                                                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                              • Slide 215
                                                                                                                                                                                                              • Slide 216
                                                                                                                                                                                                              • Slide 217
                                                                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                              • A challengehellip
                                                                                                                                                                                                              • Slide 222

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Inna ldquoI just get blank I usually start sitting more slouched hold my head with my left hand hellipyou freeze and instead of being able to think of alternatives you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to yourdquo

                                                                                                                                                                                                                Lend Me Your Brain

                                                                                                                                                                                                                Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                                Too busy with current activity

                                                                                                                                                                                                                Field dependent

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Sequence problem-solve

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Block out distractions

                                                                                                                                                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                - E Goldberg

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Get the reward

                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                Instant gratification vs

                                                                                                                                                                                                                executive gratification

                                                                                                                                                                                                                A B C

                                                                                                                                                                                                                behaviorx

                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                takerdquordquo

                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                thathelliprdquo

                                                                                                                                                                                                                Match the Picture

                                                                                                                                                                                                                Distraction Delay Training

                                                                                                                                                                                                                Executive Estimates Training

                                                                                                                                                                                                                X

                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                Asking two questionshellip

                                                                                                                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                                this

                                                                                                                                                                                                                what

                                                                                                                                                                                                                I se

                                                                                                                                                                                                                t out

                                                                                                                                                                                                                to

                                                                                                                                                                                                                do

                                                                                                                                                                                                                bullYesbullYes

                                                                                                                                                                                                                bullNobullYes

                                                                                                                                                                                                                bullYesbullNo

                                                                                                                                                                                                                bullNobullNo

                                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                                this

                                                                                                                                                                                                                what

                                                                                                                                                                                                                I se

                                                                                                                                                                                                                t out

                                                                                                                                                                                                                to

                                                                                                                                                                                                                do

                                                                                                                                                                                                                bullFunbullOn-task

                                                                                                                                                                                                                bullNot funbullOn-task

                                                                                                                                                                                                                bullFunbullNot on-task

                                                                                                                                                                                                                bullNot funbullNot on-task

                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                Volkow et al 2004

                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                Quarterly QI review

                                                                                                                                                                                                                The post-mortem

                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                Yoga read

                                                                                                                                                                                                                Staff meeting

                                                                                                                                                                                                                Planningsession

                                                                                                                                                                                                                Phone calls

                                                                                                                                                                                                                billing

                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                Learn French

                                                                                                                                                                                                                Stop smoking

                                                                                                                                                                                                                Be a better spouse

                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                                                                DavidNowell

                                                                                                                                                                                                                • Slide 1
                                                                                                                                                                                                                • hellipa challenge
                                                                                                                                                                                                                • Slide 3
                                                                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                • Slide 7
                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                • Overview
                                                                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                                • Developmental considerations
                                                                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                • Slide 17
                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                • Slide 19
                                                                                                                                                                                                                • Strategies
                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                                • Slide 23
                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                • Slide 25
                                                                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                                                                • Slide 27
                                                                                                                                                                                                                • Slide 28
                                                                                                                                                                                                                • Slide 29
                                                                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                • Slide 35
                                                                                                                                                                                                                • Strategies (2)
                                                                                                                                                                                                                • (C)APD
                                                                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                                                                • Self-assessment
                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                • Slide 42
                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                • Core symptoms
                                                                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                                                                • Slide 53
                                                                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                                                                • Slide 63
                                                                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                • ADHD and girls
                                                                                                                                                                                                                • Slide 66
                                                                                                                                                                                                                • Slide 67
                                                                                                                                                                                                                • ADHD and women
                                                                                                                                                                                                                • Slide 69
                                                                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                • The Executive Functions
                                                                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                                                                • Slide 74
                                                                                                                                                                                                                • Slide 75
                                                                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                • Slide 84
                                                                                                                                                                                                                • Slide 85
                                                                                                                                                                                                                • Strategies (3)
                                                                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                                                                • Slide 89
                                                                                                                                                                                                                • Slide 90
                                                                                                                                                                                                                • Slide 91
                                                                                                                                                                                                                • Slide 92
                                                                                                                                                                                                                • Slide 93
                                                                                                                                                                                                                • Slide 94
                                                                                                                                                                                                                • Slide 95
                                                                                                                                                                                                                • Slide 96
                                                                                                                                                                                                                • Slide 97
                                                                                                                                                                                                                • Slide 98
                                                                                                                                                                                                                • Slide 99
                                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                                • Slide 101
                                                                                                                                                                                                                • Slide 102
                                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                                • Slide 106
                                                                                                                                                                                                                • Slide 107
                                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                                • Slide 109
                                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                                • Time Out
                                                                                                                                                                                                                • Token economy
                                                                                                                                                                                                                • Slide 113
                                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                                • Slide 115
                                                                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                                                                • Slide 117
                                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                                • Metacognition
                                                                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                • Slide 124
                                                                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                • Slide 128
                                                                                                                                                                                                                • Slide 129
                                                                                                                                                                                                                • Broaden and Build
                                                                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                • Slide 141
                                                                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                • Slide 146
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                • Slide 149
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                • Slide 152
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                • Slide 154
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                • Slide 157
                                                                                                                                                                                                                • Slide 158
                                                                                                                                                                                                                • Slide 159
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                • Slide 162
                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                • Slide 164
                                                                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                                                                • Slide 166
                                                                                                                                                                                                                • Slide 167
                                                                                                                                                                                                                • Slide 168
                                                                                                                                                                                                                • Slide 169
                                                                                                                                                                                                                • Slide 170
                                                                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                                                                • Match the Picture
                                                                                                                                                                                                                • Slide 176
                                                                                                                                                                                                                • Slide 177
                                                                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                                                                • Slide 179
                                                                                                                                                                                                                • Slide 180
                                                                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                                                                • Learning Time
                                                                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                                                                • Slide 185
                                                                                                                                                                                                                • Slide 186
                                                                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                                                                • Slide 189
                                                                                                                                                                                                                • Slide 190
                                                                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                • Slide 194
                                                                                                                                                                                                                • Slide 195
                                                                                                                                                                                                                • Slide 196
                                                                                                                                                                                                                • Slide 197
                                                                                                                                                                                                                • Slide 198
                                                                                                                                                                                                                • Slide 199
                                                                                                                                                                                                                • Slide 200
                                                                                                                                                                                                                • Slide 201
                                                                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                                                                • The post-mortem
                                                                                                                                                                                                                • Slide 204
                                                                                                                                                                                                                • Slide 205
                                                                                                                                                                                                                • Slide 206
                                                                                                                                                                                                                • Slide 207
                                                                                                                                                                                                                • Slide 208
                                                                                                                                                                                                                • Slide 209
                                                                                                                                                                                                                • Slide 210
                                                                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                                                                • Slide 212
                                                                                                                                                                                                                • Slide 213
                                                                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                • Slide 215
                                                                                                                                                                                                                • Slide 216
                                                                                                                                                                                                                • Slide 217
                                                                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                • A challengehellip
                                                                                                                                                                                                                • Slide 222

                                                                                                                                                                                                                  Lend Me Your Brain

                                                                                                                                                                                                                  Supporting Clients with Executive Dysfunction

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                                  Too busy with current activity

                                                                                                                                                                                                                  Field dependent

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Sequence problem-solve

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Block out distractions

                                                                                                                                                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                  - E Goldberg

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Get the reward

                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                  Instant gratification vs

                                                                                                                                                                                                                  executive gratification

                                                                                                                                                                                                                  A B C

                                                                                                                                                                                                                  behaviorx

                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                  takerdquordquo

                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                  thathelliprdquo

                                                                                                                                                                                                                  Match the Picture

                                                                                                                                                                                                                  Distraction Delay Training

                                                                                                                                                                                                                  Executive Estimates Training

                                                                                                                                                                                                                  X

                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                  Asking two questionshellip

                                                                                                                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                                  this

                                                                                                                                                                                                                  what

                                                                                                                                                                                                                  I se

                                                                                                                                                                                                                  t out

                                                                                                                                                                                                                  to

                                                                                                                                                                                                                  do

                                                                                                                                                                                                                  bullYesbullYes

                                                                                                                                                                                                                  bullNobullYes

                                                                                                                                                                                                                  bullYesbullNo

                                                                                                                                                                                                                  bullNobullNo

                                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                                  this

                                                                                                                                                                                                                  what

                                                                                                                                                                                                                  I se

                                                                                                                                                                                                                  t out

                                                                                                                                                                                                                  to

                                                                                                                                                                                                                  do

                                                                                                                                                                                                                  bullFunbullOn-task

                                                                                                                                                                                                                  bullNot funbullOn-task

                                                                                                                                                                                                                  bullFunbullNot on-task

                                                                                                                                                                                                                  bullNot funbullNot on-task

                                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                  Volkow et al 2004

                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                  Quarterly QI review

                                                                                                                                                                                                                  The post-mortem

                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                  Yoga read

                                                                                                                                                                                                                  Staff meeting

                                                                                                                                                                                                                  Planningsession

                                                                                                                                                                                                                  Phone calls

                                                                                                                                                                                                                  billing

                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                  Learn French

                                                                                                                                                                                                                  Stop smoking

                                                                                                                                                                                                                  Be a better spouse

                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                                                                  DavidNowell

                                                                                                                                                                                                                  • Slide 1
                                                                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                                                                  • Slide 3
                                                                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                  • Slide 7
                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                  • Overview
                                                                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                  • Slide 17
                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                  • Slide 19
                                                                                                                                                                                                                  • Strategies
                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                                  • Slide 23
                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                  • Slide 25
                                                                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                                                                  • Slide 27
                                                                                                                                                                                                                  • Slide 28
                                                                                                                                                                                                                  • Slide 29
                                                                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                  • Slide 35
                                                                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                                                                  • (C)APD
                                                                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                                                                  • Self-assessment
                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                  • Slide 42
                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                  • Core symptoms
                                                                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                                                                  • Slide 53
                                                                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                                                                  • Slide 63
                                                                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                                                                  • Slide 66
                                                                                                                                                                                                                  • Slide 67
                                                                                                                                                                                                                  • ADHD and women
                                                                                                                                                                                                                  • Slide 69
                                                                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                                                                  • Slide 74
                                                                                                                                                                                                                  • Slide 75
                                                                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                  • Slide 84
                                                                                                                                                                                                                  • Slide 85
                                                                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                                                                  • Slide 89
                                                                                                                                                                                                                  • Slide 90
                                                                                                                                                                                                                  • Slide 91
                                                                                                                                                                                                                  • Slide 92
                                                                                                                                                                                                                  • Slide 93
                                                                                                                                                                                                                  • Slide 94
                                                                                                                                                                                                                  • Slide 95
                                                                                                                                                                                                                  • Slide 96
                                                                                                                                                                                                                  • Slide 97
                                                                                                                                                                                                                  • Slide 98
                                                                                                                                                                                                                  • Slide 99
                                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                                  • Slide 101
                                                                                                                                                                                                                  • Slide 102
                                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                                  • Slide 106
                                                                                                                                                                                                                  • Slide 107
                                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                                  • Slide 109
                                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                                  • Time Out
                                                                                                                                                                                                                  • Token economy
                                                                                                                                                                                                                  • Slide 113
                                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                                  • Slide 115
                                                                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                                                                  • Slide 117
                                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                                  • Metacognition
                                                                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                  • Slide 124
                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                  • Slide 128
                                                                                                                                                                                                                  • Slide 129
                                                                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                  • Slide 141
                                                                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                  • Slide 146
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                  • Slide 149
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                  • Slide 152
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                  • Slide 154
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                  • Slide 157
                                                                                                                                                                                                                  • Slide 158
                                                                                                                                                                                                                  • Slide 159
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                  • Slide 162
                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                  • Slide 164
                                                                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                                                                  • Slide 166
                                                                                                                                                                                                                  • Slide 167
                                                                                                                                                                                                                  • Slide 168
                                                                                                                                                                                                                  • Slide 169
                                                                                                                                                                                                                  • Slide 170
                                                                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                                                                  • Match the Picture
                                                                                                                                                                                                                  • Slide 176
                                                                                                                                                                                                                  • Slide 177
                                                                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                                                                  • Slide 179
                                                                                                                                                                                                                  • Slide 180
                                                                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                                                                  • Learning Time
                                                                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                                                                  • Slide 185
                                                                                                                                                                                                                  • Slide 186
                                                                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                                                                  • Slide 189
                                                                                                                                                                                                                  • Slide 190
                                                                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                  • Slide 194
                                                                                                                                                                                                                  • Slide 195
                                                                                                                                                                                                                  • Slide 196
                                                                                                                                                                                                                  • Slide 197
                                                                                                                                                                                                                  • Slide 198
                                                                                                                                                                                                                  • Slide 199
                                                                                                                                                                                                                  • Slide 200
                                                                                                                                                                                                                  • Slide 201
                                                                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                                                                  • The post-mortem
                                                                                                                                                                                                                  • Slide 204
                                                                                                                                                                                                                  • Slide 205
                                                                                                                                                                                                                  • Slide 206
                                                                                                                                                                                                                  • Slide 207
                                                                                                                                                                                                                  • Slide 208
                                                                                                                                                                                                                  • Slide 209
                                                                                                                                                                                                                  • Slide 210
                                                                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                                                                  • Slide 212
                                                                                                                                                                                                                  • Slide 213
                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                  • Slide 215
                                                                                                                                                                                                                  • Slide 216
                                                                                                                                                                                                                  • Slide 217
                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                  • A challengehellip
                                                                                                                                                                                                                  • Slide 222

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Hank ldquoI have things I need to do to improve my marriage my health and my financial situation but I honestly believe that I have zero chance of actually making any of those three things actually get better rdquo

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                                    Too busy with current activity

                                                                                                                                                                                                                    Field dependent

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Sequence problem-solve

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Block out distractions

                                                                                                                                                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                    - E Goldberg

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Get the reward

                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                    Instant gratification vs

                                                                                                                                                                                                                    executive gratification

                                                                                                                                                                                                                    A B C

                                                                                                                                                                                                                    behaviorx

                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                    takerdquordquo

                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                    thathelliprdquo

                                                                                                                                                                                                                    Match the Picture

                                                                                                                                                                                                                    Distraction Delay Training

                                                                                                                                                                                                                    Executive Estimates Training

                                                                                                                                                                                                                    X

                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                    Asking two questionshellip

                                                                                                                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                                    this

                                                                                                                                                                                                                    what

                                                                                                                                                                                                                    I se

                                                                                                                                                                                                                    t out

                                                                                                                                                                                                                    to

                                                                                                                                                                                                                    do

                                                                                                                                                                                                                    bullYesbullYes

                                                                                                                                                                                                                    bullNobullYes

                                                                                                                                                                                                                    bullYesbullNo

                                                                                                                                                                                                                    bullNobullNo

                                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                                    this

                                                                                                                                                                                                                    what

                                                                                                                                                                                                                    I se

                                                                                                                                                                                                                    t out

                                                                                                                                                                                                                    to

                                                                                                                                                                                                                    do

                                                                                                                                                                                                                    bullFunbullOn-task

                                                                                                                                                                                                                    bullNot funbullOn-task

                                                                                                                                                                                                                    bullFunbullNot on-task

                                                                                                                                                                                                                    bullNot funbullNot on-task

                                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                    Volkow et al 2004

                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                    Quarterly QI review

                                                                                                                                                                                                                    The post-mortem

                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                    Yoga read

                                                                                                                                                                                                                    Staff meeting

                                                                                                                                                                                                                    Planningsession

                                                                                                                                                                                                                    Phone calls

                                                                                                                                                                                                                    billing

                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                    Learn French

                                                                                                                                                                                                                    Stop smoking

                                                                                                                                                                                                                    Be a better spouse

                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                                                                    DavidNowell

                                                                                                                                                                                                                    • Slide 1
                                                                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                                                                    • Slide 3
                                                                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                    • Slide 7
                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                    • Overview
                                                                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                    • Slide 17
                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                    • Slide 19
                                                                                                                                                                                                                    • Strategies
                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                                    • Slide 23
                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                    • Slide 25
                                                                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                                                                    • Slide 27
                                                                                                                                                                                                                    • Slide 28
                                                                                                                                                                                                                    • Slide 29
                                                                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                    • Slide 35
                                                                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                                                                    • (C)APD
                                                                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                                                                    • Self-assessment
                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                    • Slide 42
                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                    • Core symptoms
                                                                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                                                                    • Slide 53
                                                                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                                                                    • Slide 63
                                                                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                                                                    • Slide 66
                                                                                                                                                                                                                    • Slide 67
                                                                                                                                                                                                                    • ADHD and women
                                                                                                                                                                                                                    • Slide 69
                                                                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                                                                    • Slide 74
                                                                                                                                                                                                                    • Slide 75
                                                                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                    • Slide 84
                                                                                                                                                                                                                    • Slide 85
                                                                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                                                                    • Slide 89
                                                                                                                                                                                                                    • Slide 90
                                                                                                                                                                                                                    • Slide 91
                                                                                                                                                                                                                    • Slide 92
                                                                                                                                                                                                                    • Slide 93
                                                                                                                                                                                                                    • Slide 94
                                                                                                                                                                                                                    • Slide 95
                                                                                                                                                                                                                    • Slide 96
                                                                                                                                                                                                                    • Slide 97
                                                                                                                                                                                                                    • Slide 98
                                                                                                                                                                                                                    • Slide 99
                                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                                    • Slide 101
                                                                                                                                                                                                                    • Slide 102
                                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                                    • Slide 106
                                                                                                                                                                                                                    • Slide 107
                                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                                    • Slide 109
                                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                                    • Time Out
                                                                                                                                                                                                                    • Token economy
                                                                                                                                                                                                                    • Slide 113
                                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                                    • Slide 115
                                                                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                                                                    • Slide 117
                                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                                    • Metacognition
                                                                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                    • Slide 124
                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                    • Slide 128
                                                                                                                                                                                                                    • Slide 129
                                                                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                    • Slide 141
                                                                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                    • Slide 146
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                    • Slide 149
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                    • Slide 152
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                    • Slide 154
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                    • Slide 157
                                                                                                                                                                                                                    • Slide 158
                                                                                                                                                                                                                    • Slide 159
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                    • Slide 162
                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                    • Slide 164
                                                                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                                                                    • Slide 166
                                                                                                                                                                                                                    • Slide 167
                                                                                                                                                                                                                    • Slide 168
                                                                                                                                                                                                                    • Slide 169
                                                                                                                                                                                                                    • Slide 170
                                                                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                                                                    • Match the Picture
                                                                                                                                                                                                                    • Slide 176
                                                                                                                                                                                                                    • Slide 177
                                                                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                                                                    • Slide 179
                                                                                                                                                                                                                    • Slide 180
                                                                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                                                                    • Learning Time
                                                                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                                                                    • Slide 185
                                                                                                                                                                                                                    • Slide 186
                                                                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                                                                    • Slide 189
                                                                                                                                                                                                                    • Slide 190
                                                                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                    • Slide 194
                                                                                                                                                                                                                    • Slide 195
                                                                                                                                                                                                                    • Slide 196
                                                                                                                                                                                                                    • Slide 197
                                                                                                                                                                                                                    • Slide 198
                                                                                                                                                                                                                    • Slide 199
                                                                                                                                                                                                                    • Slide 200
                                                                                                                                                                                                                    • Slide 201
                                                                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                                                                    • The post-mortem
                                                                                                                                                                                                                    • Slide 204
                                                                                                                                                                                                                    • Slide 205
                                                                                                                                                                                                                    • Slide 206
                                                                                                                                                                                                                    • Slide 207
                                                                                                                                                                                                                    • Slide 208
                                                                                                                                                                                                                    • Slide 209
                                                                                                                                                                                                                    • Slide 210
                                                                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                                                                    • Slide 212
                                                                                                                                                                                                                    • Slide 213
                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                    • Slide 215
                                                                                                                                                                                                                    • Slide 216
                                                                                                                                                                                                                    • Slide 217
                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                    • A challengehellip
                                                                                                                                                                                                                    • Slide 222

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Alice a oach from Long Island The difference between a dream and a goal is a plan It is the myriad of steps BETWEEN point A and point B that fail to happen That is why a coach can be so important to folks with ADHD A coach can help the person develop a step-by-step plan and help the person decide which steps they can amp will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones)

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                                      Too busy with current activity

                                                                                                                                                                                                                      Field dependent

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Sequence problem-solve

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Block out distractions

                                                                                                                                                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                      - E Goldberg

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Get the reward

                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                      Instant gratification vs

                                                                                                                                                                                                                      executive gratification

                                                                                                                                                                                                                      A B C

                                                                                                                                                                                                                      behaviorx

                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                      takerdquordquo

                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                      thathelliprdquo

                                                                                                                                                                                                                      Match the Picture

                                                                                                                                                                                                                      Distraction Delay Training

                                                                                                                                                                                                                      Executive Estimates Training

                                                                                                                                                                                                                      X

                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                      Asking two questionshellip

                                                                                                                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                                      this

                                                                                                                                                                                                                      what

                                                                                                                                                                                                                      I se

                                                                                                                                                                                                                      t out

                                                                                                                                                                                                                      to

                                                                                                                                                                                                                      do

                                                                                                                                                                                                                      bullYesbullYes

                                                                                                                                                                                                                      bullNobullYes

                                                                                                                                                                                                                      bullYesbullNo

                                                                                                                                                                                                                      bullNobullNo

                                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                                      this

                                                                                                                                                                                                                      what

                                                                                                                                                                                                                      I se

                                                                                                                                                                                                                      t out

                                                                                                                                                                                                                      to

                                                                                                                                                                                                                      do

                                                                                                                                                                                                                      bullFunbullOn-task

                                                                                                                                                                                                                      bullNot funbullOn-task

                                                                                                                                                                                                                      bullFunbullNot on-task

                                                                                                                                                                                                                      bullNot funbullNot on-task

                                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                      Volkow et al 2004

                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                      Quarterly QI review

                                                                                                                                                                                                                      The post-mortem

                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                      Yoga read

                                                                                                                                                                                                                      Staff meeting

                                                                                                                                                                                                                      Planningsession

                                                                                                                                                                                                                      Phone calls

                                                                                                                                                                                                                      billing

                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                      Learn French

                                                                                                                                                                                                                      Stop smoking

                                                                                                                                                                                                                      Be a better spouse

                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                                                                                      DavidNowell

                                                                                                                                                                                                                      • Slide 1
                                                                                                                                                                                                                      • hellipa challenge
                                                                                                                                                                                                                      • Slide 3
                                                                                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                      • Slide 7
                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                      • Overview
                                                                                                                                                                                                                      • This Dense Pudding
                                                                                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                                                      • Developmental considerations
                                                                                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                      • Slide 17
                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                      • Slide 19
                                                                                                                                                                                                                      • Strategies
                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                                                      • Slide 23
                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                      • Slide 25
                                                                                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                                                                                      • Slide 27
                                                                                                                                                                                                                      • Slide 28
                                                                                                                                                                                                                      • Slide 29
                                                                                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                      • Slide 35
                                                                                                                                                                                                                      • Strategies (2)
                                                                                                                                                                                                                      • (C)APD
                                                                                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                                                                                      • Self-assessment
                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                      • Slide 42
                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                      • Core symptoms
                                                                                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                                                                                      • Slide 53
                                                                                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                                                                                      • Slide 63
                                                                                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                      • ADHD and girls
                                                                                                                                                                                                                      • Slide 66
                                                                                                                                                                                                                      • Slide 67
                                                                                                                                                                                                                      • ADHD and women
                                                                                                                                                                                                                      • Slide 69
                                                                                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                      • The Executive Functions
                                                                                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                                                                                      • Slide 74
                                                                                                                                                                                                                      • Slide 75
                                                                                                                                                                                                                      • Appropriate expectations
                                                                                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                      • Slide 84
                                                                                                                                                                                                                      • Slide 85
                                                                                                                                                                                                                      • Strategies (3)
                                                                                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                                                                                      • Behavioral Supports
                                                                                                                                                                                                                      • Slide 89
                                                                                                                                                                                                                      • Slide 90
                                                                                                                                                                                                                      • Slide 91
                                                                                                                                                                                                                      • Slide 92
                                                                                                                                                                                                                      • Slide 93
                                                                                                                                                                                                                      • Slide 94
                                                                                                                                                                                                                      • Slide 95
                                                                                                                                                                                                                      • Slide 96
                                                                                                                                                                                                                      • Slide 97
                                                                                                                                                                                                                      • Slide 98
                                                                                                                                                                                                                      • Slide 99
                                                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                                                      • Slide 101
                                                                                                                                                                                                                      • Slide 102
                                                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                                                      • Slide 106
                                                                                                                                                                                                                      • Slide 107
                                                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                                                      • Slide 109
                                                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                                                      • Time Out
                                                                                                                                                                                                                      • Token economy
                                                                                                                                                                                                                      • Slide 113
                                                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                                                      • Slide 115
                                                                                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                                                                                      • Slide 117
                                                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                                                      • Metacognition
                                                                                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                      • Slide 124
                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                      • Slide 128
                                                                                                                                                                                                                      • Slide 129
                                                                                                                                                                                                                      • Broaden and Build
                                                                                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                      • Slide 141
                                                                                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                      • Slide 146
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                      • Slide 149
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                      • Slide 152
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                      • Slide 154
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                      • Slide 157
                                                                                                                                                                                                                      • Slide 158
                                                                                                                                                                                                                      • Slide 159
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                      • Slide 162
                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                      • Slide 164
                                                                                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                                                                                      • Slide 166
                                                                                                                                                                                                                      • Slide 167
                                                                                                                                                                                                                      • Slide 168
                                                                                                                                                                                                                      • Slide 169
                                                                                                                                                                                                                      • Slide 170
                                                                                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                                                                                      • Match the Picture
                                                                                                                                                                                                                      • Slide 176
                                                                                                                                                                                                                      • Slide 177
                                                                                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                                                                                      • Slide 179
                                                                                                                                                                                                                      • Slide 180
                                                                                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                                                                                      • Learning Time
                                                                                                                                                                                                                      • Learning Time (2)
                                                                                                                                                                                                                      • Learning Time (3)
                                                                                                                                                                                                                      • Slide 185
                                                                                                                                                                                                                      • Slide 186
                                                                                                                                                                                                                      • Learning Time (4)
                                                                                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                                                                                      • Slide 189
                                                                                                                                                                                                                      • Slide 190
                                                                                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                      • Slide 194
                                                                                                                                                                                                                      • Slide 195
                                                                                                                                                                                                                      • Slide 196
                                                                                                                                                                                                                      • Slide 197
                                                                                                                                                                                                                      • Slide 198
                                                                                                                                                                                                                      • Slide 199
                                                                                                                                                                                                                      • Slide 200
                                                                                                                                                                                                                      • Slide 201
                                                                                                                                                                                                                      • Quarterly QI review
                                                                                                                                                                                                                      • The post-mortem
                                                                                                                                                                                                                      • Slide 204
                                                                                                                                                                                                                      • Slide 205
                                                                                                                                                                                                                      • Slide 206
                                                                                                                                                                                                                      • Slide 207
                                                                                                                                                                                                                      • Slide 208
                                                                                                                                                                                                                      • Slide 209
                                                                                                                                                                                                                      • Slide 210
                                                                                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                                                                                      • Slide 212
                                                                                                                                                                                                                      • Slide 213
                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                      • Slide 215
                                                                                                                                                                                                                      • Slide 216
                                                                                                                                                                                                                      • Slide 217
                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                      • A challengehellip
                                                                                                                                                                                                                      • Slide 222

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Anticipate goal (state) Identify tasks Sequence problem-solve Block out distractions Get the reward

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                                        Too busy with current activity

                                                                                                                                                                                                                        Field dependent

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Sequence problem-solve

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Block out distractions

                                                                                                                                                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                        - E Goldberg

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Get the reward

                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                        Instant gratification vs

                                                                                                                                                                                                                        executive gratification

                                                                                                                                                                                                                        A B C

                                                                                                                                                                                                                        behaviorx

                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                        takerdquordquo

                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                        thathelliprdquo

                                                                                                                                                                                                                        Match the Picture

                                                                                                                                                                                                                        Distraction Delay Training

                                                                                                                                                                                                                        Executive Estimates Training

                                                                                                                                                                                                                        X

                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                        Asking two questionshellip

                                                                                                                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                                        this

                                                                                                                                                                                                                        what

                                                                                                                                                                                                                        I se

                                                                                                                                                                                                                        t out

                                                                                                                                                                                                                        to

                                                                                                                                                                                                                        do

                                                                                                                                                                                                                        bullYesbullYes

                                                                                                                                                                                                                        bullNobullYes

                                                                                                                                                                                                                        bullYesbullNo

                                                                                                                                                                                                                        bullNobullNo

                                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                                        this

                                                                                                                                                                                                                        what

                                                                                                                                                                                                                        I se

                                                                                                                                                                                                                        t out

                                                                                                                                                                                                                        to

                                                                                                                                                                                                                        do

                                                                                                                                                                                                                        bullFunbullOn-task

                                                                                                                                                                                                                        bullNot funbullOn-task

                                                                                                                                                                                                                        bullFunbullNot on-task

                                                                                                                                                                                                                        bullNot funbullNot on-task

                                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                        Volkow et al 2004

                                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                                        Quarterly QI review

                                                                                                                                                                                                                        The post-mortem

                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                        Yoga read

                                                                                                                                                                                                                        Staff meeting

                                                                                                                                                                                                                        Planningsession

                                                                                                                                                                                                                        Phone calls

                                                                                                                                                                                                                        billing

                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                        Learn French

                                                                                                                                                                                                                        Stop smoking

                                                                                                                                                                                                                        Be a better spouse

                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                                                                                        DavidNowell

                                                                                                                                                                                                                        • Slide 1
                                                                                                                                                                                                                        • hellipa challenge
                                                                                                                                                                                                                        • Slide 3
                                                                                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                        • Slide 7
                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                        • Overview
                                                                                                                                                                                                                        • This Dense Pudding
                                                                                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                                                        • Developmental considerations
                                                                                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                        • Slide 17
                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                        • Slide 19
                                                                                                                                                                                                                        • Strategies
                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                                                        • Slide 23
                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                        • Slide 25
                                                                                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                                                                                        • Slide 27
                                                                                                                                                                                                                        • Slide 28
                                                                                                                                                                                                                        • Slide 29
                                                                                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                        • Slide 35
                                                                                                                                                                                                                        • Strategies (2)
                                                                                                                                                                                                                        • (C)APD
                                                                                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                                                                                        • Self-assessment
                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                        • Slide 42
                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                        • Core symptoms
                                                                                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                                                                                        • Slide 53
                                                                                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                                                                                        • Slide 63
                                                                                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                        • ADHD and girls
                                                                                                                                                                                                                        • Slide 66
                                                                                                                                                                                                                        • Slide 67
                                                                                                                                                                                                                        • ADHD and women
                                                                                                                                                                                                                        • Slide 69
                                                                                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                        • The Executive Functions
                                                                                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                                                                                        • Slide 74
                                                                                                                                                                                                                        • Slide 75
                                                                                                                                                                                                                        • Appropriate expectations
                                                                                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                        • Slide 84
                                                                                                                                                                                                                        • Slide 85
                                                                                                                                                                                                                        • Strategies (3)
                                                                                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                                                                                        • Behavioral Supports
                                                                                                                                                                                                                        • Slide 89
                                                                                                                                                                                                                        • Slide 90
                                                                                                                                                                                                                        • Slide 91
                                                                                                                                                                                                                        • Slide 92
                                                                                                                                                                                                                        • Slide 93
                                                                                                                                                                                                                        • Slide 94
                                                                                                                                                                                                                        • Slide 95
                                                                                                                                                                                                                        • Slide 96
                                                                                                                                                                                                                        • Slide 97
                                                                                                                                                                                                                        • Slide 98
                                                                                                                                                                                                                        • Slide 99
                                                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                                                        • Slide 101
                                                                                                                                                                                                                        • Slide 102
                                                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                                                        • Slide 106
                                                                                                                                                                                                                        • Slide 107
                                                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                                                        • Slide 109
                                                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                                                        • Time Out
                                                                                                                                                                                                                        • Token economy
                                                                                                                                                                                                                        • Slide 113
                                                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                                                        • Slide 115
                                                                                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                                                                                        • Slide 117
                                                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                                                        • Metacognition
                                                                                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                        • Slide 124
                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                        • Slide 128
                                                                                                                                                                                                                        • Slide 129
                                                                                                                                                                                                                        • Broaden and Build
                                                                                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                        • Slide 141
                                                                                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                        • Slide 146
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                        • Slide 149
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                        • Slide 152
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                        • Slide 154
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                        • Slide 157
                                                                                                                                                                                                                        • Slide 158
                                                                                                                                                                                                                        • Slide 159
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                        • Slide 162
                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                        • Slide 164
                                                                                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                                                                                        • Slide 166
                                                                                                                                                                                                                        • Slide 167
                                                                                                                                                                                                                        • Slide 168
                                                                                                                                                                                                                        • Slide 169
                                                                                                                                                                                                                        • Slide 170
                                                                                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                                                                                        • Match the Picture
                                                                                                                                                                                                                        • Slide 176
                                                                                                                                                                                                                        • Slide 177
                                                                                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                                                                                        • Slide 179
                                                                                                                                                                                                                        • Slide 180
                                                                                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                                                                                        • Learning Time
                                                                                                                                                                                                                        • Learning Time (2)
                                                                                                                                                                                                                        • Learning Time (3)
                                                                                                                                                                                                                        • Slide 185
                                                                                                                                                                                                                        • Slide 186
                                                                                                                                                                                                                        • Learning Time (4)
                                                                                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                                                                                        • Slide 189
                                                                                                                                                                                                                        • Slide 190
                                                                                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                        • Slide 194
                                                                                                                                                                                                                        • Slide 195
                                                                                                                                                                                                                        • Slide 196
                                                                                                                                                                                                                        • Slide 197
                                                                                                                                                                                                                        • Slide 198
                                                                                                                                                                                                                        • Slide 199
                                                                                                                                                                                                                        • Slide 200
                                                                                                                                                                                                                        • Slide 201
                                                                                                                                                                                                                        • Quarterly QI review
                                                                                                                                                                                                                        • The post-mortem
                                                                                                                                                                                                                        • Slide 204
                                                                                                                                                                                                                        • Slide 205
                                                                                                                                                                                                                        • Slide 206
                                                                                                                                                                                                                        • Slide 207
                                                                                                                                                                                                                        • Slide 208
                                                                                                                                                                                                                        • Slide 209
                                                                                                                                                                                                                        • Slide 210
                                                                                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                                                                                        • Slide 212
                                                                                                                                                                                                                        • Slide 213
                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                        • Slide 215
                                                                                                                                                                                                                        • Slide 216
                                                                                                                                                                                                                        • Slide 217
                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                        • A challengehellip
                                                                                                                                                                                                                        • Slide 222

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Anticipate goal (state) Working memory Insight Alexithymia emotional intelligence Disconnect from values Diminished options Overly influenced by externals

                                                                                                                                                                                                                          Too busy with current activity

                                                                                                                                                                                                                          Field dependent

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Sequence problem-solve

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Block out distractions

                                                                                                                                                                                                                          The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                          - E Goldberg

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Get the reward

                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                          Instant gratification vs

                                                                                                                                                                                                                          executive gratification

                                                                                                                                                                                                                          A B C

                                                                                                                                                                                                                          behaviorx

                                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                          takerdquordquo

                                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                          thathelliprdquo

                                                                                                                                                                                                                          Match the Picture

                                                                                                                                                                                                                          Distraction Delay Training

                                                                                                                                                                                                                          Executive Estimates Training

                                                                                                                                                                                                                          X

                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                          Asking two questionshellip

                                                                                                                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                                          this

                                                                                                                                                                                                                          what

                                                                                                                                                                                                                          I se

                                                                                                                                                                                                                          t out

                                                                                                                                                                                                                          to

                                                                                                                                                                                                                          do

                                                                                                                                                                                                                          bullYesbullYes

                                                                                                                                                                                                                          bullNobullYes

                                                                                                                                                                                                                          bullYesbullNo

                                                                                                                                                                                                                          bullNobullNo

                                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                                          this

                                                                                                                                                                                                                          what

                                                                                                                                                                                                                          I se

                                                                                                                                                                                                                          t out

                                                                                                                                                                                                                          to

                                                                                                                                                                                                                          do

                                                                                                                                                                                                                          bullFunbullOn-task

                                                                                                                                                                                                                          bullNot funbullOn-task

                                                                                                                                                                                                                          bullFunbullNot on-task

                                                                                                                                                                                                                          bullNot funbullNot on-task

                                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                          Volkow et al 2004

                                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                                          Quarterly QI review

                                                                                                                                                                                                                          The post-mortem

                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                          Yoga read

                                                                                                                                                                                                                          Staff meeting

                                                                                                                                                                                                                          Planningsession

                                                                                                                                                                                                                          Phone calls

                                                                                                                                                                                                                          billing

                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                          Learn French

                                                                                                                                                                                                                          Stop smoking

                                                                                                                                                                                                                          Be a better spouse

                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                                                                                          DavidNowell

                                                                                                                                                                                                                          • Slide 1
                                                                                                                                                                                                                          • hellipa challenge
                                                                                                                                                                                                                          • Slide 3
                                                                                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                          • Slide 7
                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                          • Overview
                                                                                                                                                                                                                          • This Dense Pudding
                                                                                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                                                          • Developmental considerations
                                                                                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                          • Slide 17
                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                          • Slide 19
                                                                                                                                                                                                                          • Strategies
                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                                                          • Slide 23
                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                          • Slide 25
                                                                                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                                                                                          • Slide 27
                                                                                                                                                                                                                          • Slide 28
                                                                                                                                                                                                                          • Slide 29
                                                                                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                          • Slide 35
                                                                                                                                                                                                                          • Strategies (2)
                                                                                                                                                                                                                          • (C)APD
                                                                                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                                                                                          • Self-assessment
                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                          • Slide 42
                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                          • Core symptoms
                                                                                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                                                                                          • Slide 53
                                                                                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                                                                                          • Slide 63
                                                                                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                          • ADHD and girls
                                                                                                                                                                                                                          • Slide 66
                                                                                                                                                                                                                          • Slide 67
                                                                                                                                                                                                                          • ADHD and women
                                                                                                                                                                                                                          • Slide 69
                                                                                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                          • The Executive Functions
                                                                                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                                                                                          • Slide 74
                                                                                                                                                                                                                          • Slide 75
                                                                                                                                                                                                                          • Appropriate expectations
                                                                                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                          • Slide 84
                                                                                                                                                                                                                          • Slide 85
                                                                                                                                                                                                                          • Strategies (3)
                                                                                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                                                                                          • Behavioral Supports
                                                                                                                                                                                                                          • Slide 89
                                                                                                                                                                                                                          • Slide 90
                                                                                                                                                                                                                          • Slide 91
                                                                                                                                                                                                                          • Slide 92
                                                                                                                                                                                                                          • Slide 93
                                                                                                                                                                                                                          • Slide 94
                                                                                                                                                                                                                          • Slide 95
                                                                                                                                                                                                                          • Slide 96
                                                                                                                                                                                                                          • Slide 97
                                                                                                                                                                                                                          • Slide 98
                                                                                                                                                                                                                          • Slide 99
                                                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                                                          • Slide 101
                                                                                                                                                                                                                          • Slide 102
                                                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                                                          • Slide 106
                                                                                                                                                                                                                          • Slide 107
                                                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                                                          • Slide 109
                                                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                                                          • Time Out
                                                                                                                                                                                                                          • Token economy
                                                                                                                                                                                                                          • Slide 113
                                                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                                                          • Slide 115
                                                                                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                                                                                          • Slide 117
                                                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                                                          • Metacognition
                                                                                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                          • Slide 124
                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                          • Slide 128
                                                                                                                                                                                                                          • Slide 129
                                                                                                                                                                                                                          • Broaden and Build
                                                                                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                          • Slide 141
                                                                                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                          • Slide 146
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                          • Slide 149
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                          • Slide 152
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                          • Slide 154
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                          • Slide 157
                                                                                                                                                                                                                          • Slide 158
                                                                                                                                                                                                                          • Slide 159
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                          • Slide 162
                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                          • Slide 164
                                                                                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                                                                                          • Slide 166
                                                                                                                                                                                                                          • Slide 167
                                                                                                                                                                                                                          • Slide 168
                                                                                                                                                                                                                          • Slide 169
                                                                                                                                                                                                                          • Slide 170
                                                                                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                                                                                          • Match the Picture
                                                                                                                                                                                                                          • Slide 176
                                                                                                                                                                                                                          • Slide 177
                                                                                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                                                                                          • Slide 179
                                                                                                                                                                                                                          • Slide 180
                                                                                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                                                                                          • Learning Time
                                                                                                                                                                                                                          • Learning Time (2)
                                                                                                                                                                                                                          • Learning Time (3)
                                                                                                                                                                                                                          • Slide 185
                                                                                                                                                                                                                          • Slide 186
                                                                                                                                                                                                                          • Learning Time (4)
                                                                                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                                                                                          • Slide 189
                                                                                                                                                                                                                          • Slide 190
                                                                                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                          • Slide 194
                                                                                                                                                                                                                          • Slide 195
                                                                                                                                                                                                                          • Slide 196
                                                                                                                                                                                                                          • Slide 197
                                                                                                                                                                                                                          • Slide 198
                                                                                                                                                                                                                          • Slide 199
                                                                                                                                                                                                                          • Slide 200
                                                                                                                                                                                                                          • Slide 201
                                                                                                                                                                                                                          • Quarterly QI review
                                                                                                                                                                                                                          • The post-mortem
                                                                                                                                                                                                                          • Slide 204
                                                                                                                                                                                                                          • Slide 205
                                                                                                                                                                                                                          • Slide 206
                                                                                                                                                                                                                          • Slide 207
                                                                                                                                                                                                                          • Slide 208
                                                                                                                                                                                                                          • Slide 209
                                                                                                                                                                                                                          • Slide 210
                                                                                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                                                                                          • Slide 212
                                                                                                                                                                                                                          • Slide 213
                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                          • Slide 215
                                                                                                                                                                                                                          • Slide 216
                                                                                                                                                                                                                          • Slide 217
                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                          • A challengehellip
                                                                                                                                                                                                                          • Slide 222

                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                            Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                            Sequence problem-solve

                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                            Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                            Block out distractions

                                                                                                                                                                                                                            The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                            - E Goldberg

                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                            Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                            Get the reward

                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                            Instant gratification vs

                                                                                                                                                                                                                            executive gratification

                                                                                                                                                                                                                            A B C

                                                                                                                                                                                                                            behaviorx

                                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                            takerdquordquo

                                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                            thathelliprdquo

                                                                                                                                                                                                                            Match the Picture

                                                                                                                                                                                                                            Distraction Delay Training

                                                                                                                                                                                                                            Executive Estimates Training

                                                                                                                                                                                                                            X

                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                            Asking two questionshellip

                                                                                                                                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                                            this

                                                                                                                                                                                                                            what

                                                                                                                                                                                                                            I se

                                                                                                                                                                                                                            t out

                                                                                                                                                                                                                            to

                                                                                                                                                                                                                            do

                                                                                                                                                                                                                            bullYesbullYes

                                                                                                                                                                                                                            bullNobullYes

                                                                                                                                                                                                                            bullYesbullNo

                                                                                                                                                                                                                            bullNobullNo

                                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                                            this

                                                                                                                                                                                                                            what

                                                                                                                                                                                                                            I se

                                                                                                                                                                                                                            t out

                                                                                                                                                                                                                            to

                                                                                                                                                                                                                            do

                                                                                                                                                                                                                            bullFunbullOn-task

                                                                                                                                                                                                                            bullNot funbullOn-task

                                                                                                                                                                                                                            bullFunbullNot on-task

                                                                                                                                                                                                                            bullNot funbullNot on-task

                                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                            Volkow et al 2004

                                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                                            Quarterly QI review

                                                                                                                                                                                                                            The post-mortem

                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                            Yoga read

                                                                                                                                                                                                                            Staff meeting

                                                                                                                                                                                                                            Planningsession

                                                                                                                                                                                                                            Phone calls

                                                                                                                                                                                                                            billing

                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                            Learn French

                                                                                                                                                                                                                            Stop smoking

                                                                                                                                                                                                                            Be a better spouse

                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                                                                                            DavidNowell

                                                                                                                                                                                                                            • Slide 1
                                                                                                                                                                                                                            • hellipa challenge
                                                                                                                                                                                                                            • Slide 3
                                                                                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                            • Slide 7
                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                            • Overview
                                                                                                                                                                                                                            • This Dense Pudding
                                                                                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                                                            • Developmental considerations
                                                                                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                            • Slide 17
                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                            • Slide 19
                                                                                                                                                                                                                            • Strategies
                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                                                            • Slide 23
                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                            • Slide 25
                                                                                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                                                                                            • Slide 27
                                                                                                                                                                                                                            • Slide 28
                                                                                                                                                                                                                            • Slide 29
                                                                                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                            • Slide 35
                                                                                                                                                                                                                            • Strategies (2)
                                                                                                                                                                                                                            • (C)APD
                                                                                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                                                                                            • Self-assessment
                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                            • Slide 42
                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                            • Core symptoms
                                                                                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                                                                                            • Slide 53
                                                                                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                                                                                            • Slide 63
                                                                                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                            • ADHD and girls
                                                                                                                                                                                                                            • Slide 66
                                                                                                                                                                                                                            • Slide 67
                                                                                                                                                                                                                            • ADHD and women
                                                                                                                                                                                                                            • Slide 69
                                                                                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                            • The Executive Functions
                                                                                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                                                                                            • Slide 74
                                                                                                                                                                                                                            • Slide 75
                                                                                                                                                                                                                            • Appropriate expectations
                                                                                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                            • Slide 84
                                                                                                                                                                                                                            • Slide 85
                                                                                                                                                                                                                            • Strategies (3)
                                                                                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                                                                                            • Behavioral Supports
                                                                                                                                                                                                                            • Slide 89
                                                                                                                                                                                                                            • Slide 90
                                                                                                                                                                                                                            • Slide 91
                                                                                                                                                                                                                            • Slide 92
                                                                                                                                                                                                                            • Slide 93
                                                                                                                                                                                                                            • Slide 94
                                                                                                                                                                                                                            • Slide 95
                                                                                                                                                                                                                            • Slide 96
                                                                                                                                                                                                                            • Slide 97
                                                                                                                                                                                                                            • Slide 98
                                                                                                                                                                                                                            • Slide 99
                                                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                                                            • Slide 101
                                                                                                                                                                                                                            • Slide 102
                                                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                                                            • Slide 106
                                                                                                                                                                                                                            • Slide 107
                                                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                                                            • Slide 109
                                                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                                                            • Time Out
                                                                                                                                                                                                                            • Token economy
                                                                                                                                                                                                                            • Slide 113
                                                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                                                            • Slide 115
                                                                                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                                                                                            • Slide 117
                                                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                                                            • Metacognition
                                                                                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                            • Slide 124
                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                            • Slide 128
                                                                                                                                                                                                                            • Slide 129
                                                                                                                                                                                                                            • Broaden and Build
                                                                                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                            • Slide 141
                                                                                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                            • Slide 146
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                            • Slide 149
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                            • Slide 152
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                            • Slide 154
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                            • Slide 157
                                                                                                                                                                                                                            • Slide 158
                                                                                                                                                                                                                            • Slide 159
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                            • Slide 162
                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                            • Slide 164
                                                                                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                                                                                            • Slide 166
                                                                                                                                                                                                                            • Slide 167
                                                                                                                                                                                                                            • Slide 168
                                                                                                                                                                                                                            • Slide 169
                                                                                                                                                                                                                            • Slide 170
                                                                                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                                                                                            • Match the Picture
                                                                                                                                                                                                                            • Slide 176
                                                                                                                                                                                                                            • Slide 177
                                                                                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                                                                                            • Slide 179
                                                                                                                                                                                                                            • Slide 180
                                                                                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                                                                                            • Learning Time
                                                                                                                                                                                                                            • Learning Time (2)
                                                                                                                                                                                                                            • Learning Time (3)
                                                                                                                                                                                                                            • Slide 185
                                                                                                                                                                                                                            • Slide 186
                                                                                                                                                                                                                            • Learning Time (4)
                                                                                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                                                                                            • Slide 189
                                                                                                                                                                                                                            • Slide 190
                                                                                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                            • Slide 194
                                                                                                                                                                                                                            • Slide 195
                                                                                                                                                                                                                            • Slide 196
                                                                                                                                                                                                                            • Slide 197
                                                                                                                                                                                                                            • Slide 198
                                                                                                                                                                                                                            • Slide 199
                                                                                                                                                                                                                            • Slide 200
                                                                                                                                                                                                                            • Slide 201
                                                                                                                                                                                                                            • Quarterly QI review
                                                                                                                                                                                                                            • The post-mortem
                                                                                                                                                                                                                            • Slide 204
                                                                                                                                                                                                                            • Slide 205
                                                                                                                                                                                                                            • Slide 206
                                                                                                                                                                                                                            • Slide 207
                                                                                                                                                                                                                            • Slide 208
                                                                                                                                                                                                                            • Slide 209
                                                                                                                                                                                                                            • Slide 210
                                                                                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                                                                                            • Slide 212
                                                                                                                                                                                                                            • Slide 213
                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                            • Slide 215
                                                                                                                                                                                                                            • Slide 216
                                                                                                                                                                                                                            • Slide 217
                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                            • A challengehellip
                                                                                                                                                                                                                            • Slide 222

                                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                              Identify tasks Working memory Intelligence development Overly conventional thinking Insight Emotional intelligence

                                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                              Sequence problem-solve

                                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                              Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                              Block out distractions

                                                                                                                                                                                                                              The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                              - E Goldberg

                                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                              Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                              Get the reward

                                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                              Instant gratification vs

                                                                                                                                                                                                                              executive gratification

                                                                                                                                                                                                                              A B C

                                                                                                                                                                                                                              behaviorx

                                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                              takerdquordquo

                                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                              thathelliprdquo

                                                                                                                                                                                                                              Match the Picture

                                                                                                                                                                                                                              Distraction Delay Training

                                                                                                                                                                                                                              Executive Estimates Training

                                                                                                                                                                                                                              X

                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                              Asking two questionshellip

                                                                                                                                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                                                              this

                                                                                                                                                                                                                              what

                                                                                                                                                                                                                              I se

                                                                                                                                                                                                                              t out

                                                                                                                                                                                                                              to

                                                                                                                                                                                                                              do

                                                                                                                                                                                                                              bullYesbullYes

                                                                                                                                                                                                                              bullNobullYes

                                                                                                                                                                                                                              bullYesbullNo

                                                                                                                                                                                                                              bullNobullNo

                                                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                                                              this

                                                                                                                                                                                                                              what

                                                                                                                                                                                                                              I se

                                                                                                                                                                                                                              t out

                                                                                                                                                                                                                              to

                                                                                                                                                                                                                              do

                                                                                                                                                                                                                              bullFunbullOn-task

                                                                                                                                                                                                                              bullNot funbullOn-task

                                                                                                                                                                                                                              bullFunbullNot on-task

                                                                                                                                                                                                                              bullNot funbullNot on-task

                                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                              Volkow et al 2004

                                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                                              Quarterly QI review

                                                                                                                                                                                                                              The post-mortem

                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                              Yoga read

                                                                                                                                                                                                                              Staff meeting

                                                                                                                                                                                                                              Planningsession

                                                                                                                                                                                                                              Phone calls

                                                                                                                                                                                                                              billing

                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                              Learn French

                                                                                                                                                                                                                              Stop smoking

                                                                                                                                                                                                                              Be a better spouse

                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                                                                                              DavidNowell

                                                                                                                                                                                                                              • Slide 1
                                                                                                                                                                                                                              • hellipa challenge
                                                                                                                                                                                                                              • Slide 3
                                                                                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                              • Slide 7
                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                              • Overview
                                                                                                                                                                                                                              • This Dense Pudding
                                                                                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                                                              • Developmental considerations
                                                                                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                              • Slide 17
                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                              • Slide 19
                                                                                                                                                                                                                              • Strategies
                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                                                              • Slide 23
                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                              • Slide 25
                                                                                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                                                                                              • Slide 27
                                                                                                                                                                                                                              • Slide 28
                                                                                                                                                                                                                              • Slide 29
                                                                                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                              • Slide 35
                                                                                                                                                                                                                              • Strategies (2)
                                                                                                                                                                                                                              • (C)APD
                                                                                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                                                                                              • Self-assessment
                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                              • Slide 42
                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                              • Core symptoms
                                                                                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                                                                                              • Slide 53
                                                                                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                                                                                              • Slide 63
                                                                                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                              • ADHD and girls
                                                                                                                                                                                                                              • Slide 66
                                                                                                                                                                                                                              • Slide 67
                                                                                                                                                                                                                              • ADHD and women
                                                                                                                                                                                                                              • Slide 69
                                                                                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                              • The Executive Functions
                                                                                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                                                                                              • Slide 74
                                                                                                                                                                                                                              • Slide 75
                                                                                                                                                                                                                              • Appropriate expectations
                                                                                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                              • Slide 84
                                                                                                                                                                                                                              • Slide 85
                                                                                                                                                                                                                              • Strategies (3)
                                                                                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                                                                                              • Behavioral Supports
                                                                                                                                                                                                                              • Slide 89
                                                                                                                                                                                                                              • Slide 90
                                                                                                                                                                                                                              • Slide 91
                                                                                                                                                                                                                              • Slide 92
                                                                                                                                                                                                                              • Slide 93
                                                                                                                                                                                                                              • Slide 94
                                                                                                                                                                                                                              • Slide 95
                                                                                                                                                                                                                              • Slide 96
                                                                                                                                                                                                                              • Slide 97
                                                                                                                                                                                                                              • Slide 98
                                                                                                                                                                                                                              • Slide 99
                                                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                                                              • Slide 101
                                                                                                                                                                                                                              • Slide 102
                                                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                                                              • Slide 106
                                                                                                                                                                                                                              • Slide 107
                                                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                                                              • Slide 109
                                                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                                                              • Time Out
                                                                                                                                                                                                                              • Token economy
                                                                                                                                                                                                                              • Slide 113
                                                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                                                              • Slide 115
                                                                                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                                                                                              • Slide 117
                                                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                                                              • Metacognition
                                                                                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                              • Slide 124
                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                              • Slide 128
                                                                                                                                                                                                                              • Slide 129
                                                                                                                                                                                                                              • Broaden and Build
                                                                                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                              • Slide 141
                                                                                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                              • Slide 146
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                              • Slide 149
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                              • Slide 152
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                              • Slide 154
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                              • Slide 157
                                                                                                                                                                                                                              • Slide 158
                                                                                                                                                                                                                              • Slide 159
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                              • Slide 162
                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                              • Slide 164
                                                                                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                                                                                              • Slide 166
                                                                                                                                                                                                                              • Slide 167
                                                                                                                                                                                                                              • Slide 168
                                                                                                                                                                                                                              • Slide 169
                                                                                                                                                                                                                              • Slide 170
                                                                                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                                                                                              • Match the Picture
                                                                                                                                                                                                                              • Slide 176
                                                                                                                                                                                                                              • Slide 177
                                                                                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                                                                                              • Slide 179
                                                                                                                                                                                                                              • Slide 180
                                                                                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                                                                                              • Learning Time
                                                                                                                                                                                                                              • Learning Time (2)
                                                                                                                                                                                                                              • Learning Time (3)
                                                                                                                                                                                                                              • Slide 185
                                                                                                                                                                                                                              • Slide 186
                                                                                                                                                                                                                              • Learning Time (4)
                                                                                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                                                                                              • Slide 189
                                                                                                                                                                                                                              • Slide 190
                                                                                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                              • Slide 194
                                                                                                                                                                                                                              • Slide 195
                                                                                                                                                                                                                              • Slide 196
                                                                                                                                                                                                                              • Slide 197
                                                                                                                                                                                                                              • Slide 198
                                                                                                                                                                                                                              • Slide 199
                                                                                                                                                                                                                              • Slide 200
                                                                                                                                                                                                                              • Slide 201
                                                                                                                                                                                                                              • Quarterly QI review
                                                                                                                                                                                                                              • The post-mortem
                                                                                                                                                                                                                              • Slide 204
                                                                                                                                                                                                                              • Slide 205
                                                                                                                                                                                                                              • Slide 206
                                                                                                                                                                                                                              • Slide 207
                                                                                                                                                                                                                              • Slide 208
                                                                                                                                                                                                                              • Slide 209
                                                                                                                                                                                                                              • Slide 210
                                                                                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                                                                                              • Slide 212
                                                                                                                                                                                                                              • Slide 213
                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                              • Slide 215
                                                                                                                                                                                                                              • Slide 216
                                                                                                                                                                                                                              • Slide 217
                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                              • A challengehellip
                                                                                                                                                                                                                              • Slide 222

                                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                Sequence problem-solve

                                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                Block out distractions

                                                                                                                                                                                                                                The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                                - E Goldberg

                                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                Get the reward

                                                                                                                                                                                                                                Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                                Instant gratification vs

                                                                                                                                                                                                                                executive gratification

                                                                                                                                                                                                                                A B C

                                                                                                                                                                                                                                behaviorx

                                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                takerdquordquo

                                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                thathelliprdquo

                                                                                                                                                                                                                                Match the Picture

                                                                                                                                                                                                                                Distraction Delay Training

                                                                                                                                                                                                                                Executive Estimates Training

                                                                                                                                                                                                                                X

                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                Asking two questionshellip

                                                                                                                                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                                                this

                                                                                                                                                                                                                                what

                                                                                                                                                                                                                                I se

                                                                                                                                                                                                                                t out

                                                                                                                                                                                                                                to

                                                                                                                                                                                                                                do

                                                                                                                                                                                                                                bullYesbullYes

                                                                                                                                                                                                                                bullNobullYes

                                                                                                                                                                                                                                bullYesbullNo

                                                                                                                                                                                                                                bullNobullNo

                                                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                                                this

                                                                                                                                                                                                                                what

                                                                                                                                                                                                                                I se

                                                                                                                                                                                                                                t out

                                                                                                                                                                                                                                to

                                                                                                                                                                                                                                do

                                                                                                                                                                                                                                bullFunbullOn-task

                                                                                                                                                                                                                                bullNot funbullOn-task

                                                                                                                                                                                                                                bullFunbullNot on-task

                                                                                                                                                                                                                                bullNot funbullNot on-task

                                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                Volkow et al 2004

                                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                                Quarterly QI review

                                                                                                                                                                                                                                The post-mortem

                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                Yoga read

                                                                                                                                                                                                                                Staff meeting

                                                                                                                                                                                                                                Planningsession

                                                                                                                                                                                                                                Phone calls

                                                                                                                                                                                                                                billing

                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                Learn French

                                                                                                                                                                                                                                Stop smoking

                                                                                                                                                                                                                                Be a better spouse

                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                                                                                DavidNowell

                                                                                                                                                                                                                                • Slide 1
                                                                                                                                                                                                                                • hellipa challenge
                                                                                                                                                                                                                                • Slide 3
                                                                                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                • Slide 7
                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                • Overview
                                                                                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                                                • Developmental considerations
                                                                                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                • Slide 17
                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                • Slide 19
                                                                                                                                                                                                                                • Strategies
                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                                                • Slide 23
                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                • Slide 25
                                                                                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                                                                                • Slide 27
                                                                                                                                                                                                                                • Slide 28
                                                                                                                                                                                                                                • Slide 29
                                                                                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                • Slide 35
                                                                                                                                                                                                                                • Strategies (2)
                                                                                                                                                                                                                                • (C)APD
                                                                                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                                                                                • Self-assessment
                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                • Slide 42
                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                • Core symptoms
                                                                                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                • Slide 53
                                                                                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                                                                                • Slide 63
                                                                                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                • ADHD and girls
                                                                                                                                                                                                                                • Slide 66
                                                                                                                                                                                                                                • Slide 67
                                                                                                                                                                                                                                • ADHD and women
                                                                                                                                                                                                                                • Slide 69
                                                                                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                • The Executive Functions
                                                                                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                                                                                • Slide 74
                                                                                                                                                                                                                                • Slide 75
                                                                                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                • Slide 84
                                                                                                                                                                                                                                • Slide 85
                                                                                                                                                                                                                                • Strategies (3)
                                                                                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                                                                                • Slide 89
                                                                                                                                                                                                                                • Slide 90
                                                                                                                                                                                                                                • Slide 91
                                                                                                                                                                                                                                • Slide 92
                                                                                                                                                                                                                                • Slide 93
                                                                                                                                                                                                                                • Slide 94
                                                                                                                                                                                                                                • Slide 95
                                                                                                                                                                                                                                • Slide 96
                                                                                                                                                                                                                                • Slide 97
                                                                                                                                                                                                                                • Slide 98
                                                                                                                                                                                                                                • Slide 99
                                                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                                                • Slide 101
                                                                                                                                                                                                                                • Slide 102
                                                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                                                • Slide 106
                                                                                                                                                                                                                                • Slide 107
                                                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                                                • Slide 109
                                                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                                                • Time Out
                                                                                                                                                                                                                                • Token economy
                                                                                                                                                                                                                                • Slide 113
                                                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                                                • Slide 115
                                                                                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                                                                                • Slide 117
                                                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                                                • Metacognition
                                                                                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                • Slide 124
                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                • Slide 128
                                                                                                                                                                                                                                • Slide 129
                                                                                                                                                                                                                                • Broaden and Build
                                                                                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                • Slide 141
                                                                                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                • Slide 146
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                • Slide 149
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                • Slide 152
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                • Slide 154
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                • Slide 157
                                                                                                                                                                                                                                • Slide 158
                                                                                                                                                                                                                                • Slide 159
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                • Slide 162
                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                • Slide 164
                                                                                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                                                                                • Slide 166
                                                                                                                                                                                                                                • Slide 167
                                                                                                                                                                                                                                • Slide 168
                                                                                                                                                                                                                                • Slide 169
                                                                                                                                                                                                                                • Slide 170
                                                                                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                • Match the Picture
                                                                                                                                                                                                                                • Slide 176
                                                                                                                                                                                                                                • Slide 177
                                                                                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                                                                                • Slide 179
                                                                                                                                                                                                                                • Slide 180
                                                                                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                                                                                • Learning Time
                                                                                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                                                                                • Slide 185
                                                                                                                                                                                                                                • Slide 186
                                                                                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                                                                                • Slide 189
                                                                                                                                                                                                                                • Slide 190
                                                                                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                • Slide 194
                                                                                                                                                                                                                                • Slide 195
                                                                                                                                                                                                                                • Slide 196
                                                                                                                                                                                                                                • Slide 197
                                                                                                                                                                                                                                • Slide 198
                                                                                                                                                                                                                                • Slide 199
                                                                                                                                                                                                                                • Slide 200
                                                                                                                                                                                                                                • Slide 201
                                                                                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                                                                                • The post-mortem
                                                                                                                                                                                                                                • Slide 204
                                                                                                                                                                                                                                • Slide 205
                                                                                                                                                                                                                                • Slide 206
                                                                                                                                                                                                                                • Slide 207
                                                                                                                                                                                                                                • Slide 208
                                                                                                                                                                                                                                • Slide 209
                                                                                                                                                                                                                                • Slide 210
                                                                                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                • Slide 212
                                                                                                                                                                                                                                • Slide 213
                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                • Slide 215
                                                                                                                                                                                                                                • Slide 216
                                                                                                                                                                                                                                • Slide 217
                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                • A challengehellip
                                                                                                                                                                                                                                • Slide 222

                                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory

                                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                  Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                  Block out distractions

                                                                                                                                                                                                                                  The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                                  - E Goldberg

                                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                  Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                  Get the reward

                                                                                                                                                                                                                                  Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                  Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                                  Instant gratification vs

                                                                                                                                                                                                                                  executive gratification

                                                                                                                                                                                                                                  A B C

                                                                                                                                                                                                                                  behaviorx

                                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                  takerdquordquo

                                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                  thathelliprdquo

                                                                                                                                                                                                                                  Match the Picture

                                                                                                                                                                                                                                  Distraction Delay Training

                                                                                                                                                                                                                                  Executive Estimates Training

                                                                                                                                                                                                                                  X

                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                  Asking two questionshellip

                                                                                                                                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                                                  this

                                                                                                                                                                                                                                  what

                                                                                                                                                                                                                                  I se

                                                                                                                                                                                                                                  t out

                                                                                                                                                                                                                                  to

                                                                                                                                                                                                                                  do

                                                                                                                                                                                                                                  bullYesbullYes

                                                                                                                                                                                                                                  bullNobullYes

                                                                                                                                                                                                                                  bullYesbullNo

                                                                                                                                                                                                                                  bullNobullNo

                                                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                                                  this

                                                                                                                                                                                                                                  what

                                                                                                                                                                                                                                  I se

                                                                                                                                                                                                                                  t out

                                                                                                                                                                                                                                  to

                                                                                                                                                                                                                                  do

                                                                                                                                                                                                                                  bullFunbullOn-task

                                                                                                                                                                                                                                  bullNot funbullOn-task

                                                                                                                                                                                                                                  bullFunbullNot on-task

                                                                                                                                                                                                                                  bullNot funbullNot on-task

                                                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                  Volkow et al 2004

                                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                                  Quarterly QI review

                                                                                                                                                                                                                                  The post-mortem

                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                  Yoga read

                                                                                                                                                                                                                                  Staff meeting

                                                                                                                                                                                                                                  Planningsession

                                                                                                                                                                                                                                  Phone calls

                                                                                                                                                                                                                                  billing

                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                  Learn French

                                                                                                                                                                                                                                  Stop smoking

                                                                                                                                                                                                                                  Be a better spouse

                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                                                                                  DavidNowell

                                                                                                                                                                                                                                  • Slide 1
                                                                                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                                                                                  • Slide 3
                                                                                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                  • Slide 7
                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                  • Overview
                                                                                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                  • Slide 17
                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                  • Slide 19
                                                                                                                                                                                                                                  • Strategies
                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                                                  • Slide 23
                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                  • Slide 25
                                                                                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                                                                                  • Slide 27
                                                                                                                                                                                                                                  • Slide 28
                                                                                                                                                                                                                                  • Slide 29
                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                  • Slide 35
                                                                                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                                                                                  • (C)APD
                                                                                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                                                                                  • Self-assessment
                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                  • Slide 42
                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                  • Core symptoms
                                                                                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                  • Slide 53
                                                                                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                                                                                  • Slide 63
                                                                                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                                                                                  • Slide 66
                                                                                                                                                                                                                                  • Slide 67
                                                                                                                                                                                                                                  • ADHD and women
                                                                                                                                                                                                                                  • Slide 69
                                                                                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                                                                                  • Slide 74
                                                                                                                                                                                                                                  • Slide 75
                                                                                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                  • Slide 84
                                                                                                                                                                                                                                  • Slide 85
                                                                                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                                                                                  • Slide 89
                                                                                                                                                                                                                                  • Slide 90
                                                                                                                                                                                                                                  • Slide 91
                                                                                                                                                                                                                                  • Slide 92
                                                                                                                                                                                                                                  • Slide 93
                                                                                                                                                                                                                                  • Slide 94
                                                                                                                                                                                                                                  • Slide 95
                                                                                                                                                                                                                                  • Slide 96
                                                                                                                                                                                                                                  • Slide 97
                                                                                                                                                                                                                                  • Slide 98
                                                                                                                                                                                                                                  • Slide 99
                                                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                                                  • Slide 101
                                                                                                                                                                                                                                  • Slide 102
                                                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                                                  • Slide 106
                                                                                                                                                                                                                                  • Slide 107
                                                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                                                  • Slide 109
                                                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                                                  • Time Out
                                                                                                                                                                                                                                  • Token economy
                                                                                                                                                                                                                                  • Slide 113
                                                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                                                  • Slide 115
                                                                                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                                                                                  • Slide 117
                                                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                                                  • Metacognition
                                                                                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                  • Slide 124
                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                  • Slide 128
                                                                                                                                                                                                                                  • Slide 129
                                                                                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                  • Slide 141
                                                                                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                  • Slide 146
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                  • Slide 149
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                  • Slide 152
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                  • Slide 154
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                  • Slide 157
                                                                                                                                                                                                                                  • Slide 158
                                                                                                                                                                                                                                  • Slide 159
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                  • Slide 162
                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                  • Slide 164
                                                                                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                                                                                  • Slide 166
                                                                                                                                                                                                                                  • Slide 167
                                                                                                                                                                                                                                  • Slide 168
                                                                                                                                                                                                                                  • Slide 169
                                                                                                                                                                                                                                  • Slide 170
                                                                                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                  • Match the Picture
                                                                                                                                                                                                                                  • Slide 176
                                                                                                                                                                                                                                  • Slide 177
                                                                                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                                                                                  • Slide 179
                                                                                                                                                                                                                                  • Slide 180
                                                                                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                                                                                  • Learning Time
                                                                                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                                                                                  • Slide 185
                                                                                                                                                                                                                                  • Slide 186
                                                                                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                                                                                  • Slide 189
                                                                                                                                                                                                                                  • Slide 190
                                                                                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                  • Slide 194
                                                                                                                                                                                                                                  • Slide 195
                                                                                                                                                                                                                                  • Slide 196
                                                                                                                                                                                                                                  • Slide 197
                                                                                                                                                                                                                                  • Slide 198
                                                                                                                                                                                                                                  • Slide 199
                                                                                                                                                                                                                                  • Slide 200
                                                                                                                                                                                                                                  • Slide 201
                                                                                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                                                                                  • The post-mortem
                                                                                                                                                                                                                                  • Slide 204
                                                                                                                                                                                                                                  • Slide 205
                                                                                                                                                                                                                                  • Slide 206
                                                                                                                                                                                                                                  • Slide 207
                                                                                                                                                                                                                                  • Slide 208
                                                                                                                                                                                                                                  • Slide 209
                                                                                                                                                                                                                                  • Slide 210
                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                  • Slide 212
                                                                                                                                                                                                                                  • Slide 213
                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                  • Slide 215
                                                                                                                                                                                                                                  • Slide 216
                                                                                                                                                                                                                                  • Slide 217
                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                  • A challengehellip
                                                                                                                                                                                                                                  • Slide 222

                                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                    Sequence problem-solve Verbal working memory Nonverbal working memory Reconstitution Understanding of causality Self-efficacy Coping Learned helplessness

                                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                    Block out distractions

                                                                                                                                                                                                                                    The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                                    - E Goldberg

                                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                    Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                    Get the reward

                                                                                                                                                                                                                                    Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                    Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                                    Instant gratification vs

                                                                                                                                                                                                                                    executive gratification

                                                                                                                                                                                                                                    A B C

                                                                                                                                                                                                                                    behaviorx

                                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                    takerdquordquo

                                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                    thathelliprdquo

                                                                                                                                                                                                                                    Match the Picture

                                                                                                                                                                                                                                    Distraction Delay Training

                                                                                                                                                                                                                                    Executive Estimates Training

                                                                                                                                                                                                                                    X

                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                    Asking two questionshellip

                                                                                                                                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                                                    this

                                                                                                                                                                                                                                    what

                                                                                                                                                                                                                                    I se

                                                                                                                                                                                                                                    t out

                                                                                                                                                                                                                                    to

                                                                                                                                                                                                                                    do

                                                                                                                                                                                                                                    bullYesbullYes

                                                                                                                                                                                                                                    bullNobullYes

                                                                                                                                                                                                                                    bullYesbullNo

                                                                                                                                                                                                                                    bullNobullNo

                                                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                                                    this

                                                                                                                                                                                                                                    what

                                                                                                                                                                                                                                    I se

                                                                                                                                                                                                                                    t out

                                                                                                                                                                                                                                    to

                                                                                                                                                                                                                                    do

                                                                                                                                                                                                                                    bullFunbullOn-task

                                                                                                                                                                                                                                    bullNot funbullOn-task

                                                                                                                                                                                                                                    bullFunbullNot on-task

                                                                                                                                                                                                                                    bullNot funbullNot on-task

                                                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                    Volkow et al 2004

                                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                                    Quarterly QI review

                                                                                                                                                                                                                                    The post-mortem

                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                    Yoga read

                                                                                                                                                                                                                                    Staff meeting

                                                                                                                                                                                                                                    Planningsession

                                                                                                                                                                                                                                    Phone calls

                                                                                                                                                                                                                                    billing

                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                    Learn French

                                                                                                                                                                                                                                    Stop smoking

                                                                                                                                                                                                                                    Be a better spouse

                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                                                                                    DavidNowell

                                                                                                                                                                                                                                    • Slide 1
                                                                                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                                                                                    • Slide 3
                                                                                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                    • Slide 7
                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                    • Overview
                                                                                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                    • Slide 17
                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                    • Slide 19
                                                                                                                                                                                                                                    • Strategies
                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                                                    • Slide 23
                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                    • Slide 25
                                                                                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                                                                                    • Slide 27
                                                                                                                                                                                                                                    • Slide 28
                                                                                                                                                                                                                                    • Slide 29
                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                    • Slide 35
                                                                                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                                                                                    • (C)APD
                                                                                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                                                                                    • Self-assessment
                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                    • Slide 42
                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                    • Core symptoms
                                                                                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                    • Slide 53
                                                                                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                                                                                    • Slide 63
                                                                                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                                                                                    • Slide 66
                                                                                                                                                                                                                                    • Slide 67
                                                                                                                                                                                                                                    • ADHD and women
                                                                                                                                                                                                                                    • Slide 69
                                                                                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                                                                                    • Slide 74
                                                                                                                                                                                                                                    • Slide 75
                                                                                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                    • Slide 84
                                                                                                                                                                                                                                    • Slide 85
                                                                                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                                                                                    • Slide 89
                                                                                                                                                                                                                                    • Slide 90
                                                                                                                                                                                                                                    • Slide 91
                                                                                                                                                                                                                                    • Slide 92
                                                                                                                                                                                                                                    • Slide 93
                                                                                                                                                                                                                                    • Slide 94
                                                                                                                                                                                                                                    • Slide 95
                                                                                                                                                                                                                                    • Slide 96
                                                                                                                                                                                                                                    • Slide 97
                                                                                                                                                                                                                                    • Slide 98
                                                                                                                                                                                                                                    • Slide 99
                                                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                                                    • Slide 101
                                                                                                                                                                                                                                    • Slide 102
                                                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                                                    • Slide 106
                                                                                                                                                                                                                                    • Slide 107
                                                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                                                    • Slide 109
                                                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                                                    • Time Out
                                                                                                                                                                                                                                    • Token economy
                                                                                                                                                                                                                                    • Slide 113
                                                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                                                    • Slide 115
                                                                                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                                                                                    • Slide 117
                                                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                                                    • Metacognition
                                                                                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                    • Slide 124
                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                    • Slide 128
                                                                                                                                                                                                                                    • Slide 129
                                                                                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                    • Slide 141
                                                                                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                    • Slide 146
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                    • Slide 149
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                    • Slide 152
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                    • Slide 154
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                    • Slide 157
                                                                                                                                                                                                                                    • Slide 158
                                                                                                                                                                                                                                    • Slide 159
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                    • Slide 162
                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                    • Slide 164
                                                                                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                                                                                    • Slide 166
                                                                                                                                                                                                                                    • Slide 167
                                                                                                                                                                                                                                    • Slide 168
                                                                                                                                                                                                                                    • Slide 169
                                                                                                                                                                                                                                    • Slide 170
                                                                                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                    • Match the Picture
                                                                                                                                                                                                                                    • Slide 176
                                                                                                                                                                                                                                    • Slide 177
                                                                                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                                                                                    • Slide 179
                                                                                                                                                                                                                                    • Slide 180
                                                                                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                                                                                    • Learning Time
                                                                                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                                                                                    • Slide 185
                                                                                                                                                                                                                                    • Slide 186
                                                                                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                                                                                    • Slide 189
                                                                                                                                                                                                                                    • Slide 190
                                                                                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                    • Slide 194
                                                                                                                                                                                                                                    • Slide 195
                                                                                                                                                                                                                                    • Slide 196
                                                                                                                                                                                                                                    • Slide 197
                                                                                                                                                                                                                                    • Slide 198
                                                                                                                                                                                                                                    • Slide 199
                                                                                                                                                                                                                                    • Slide 200
                                                                                                                                                                                                                                    • Slide 201
                                                                                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                                                                                    • The post-mortem
                                                                                                                                                                                                                                    • Slide 204
                                                                                                                                                                                                                                    • Slide 205
                                                                                                                                                                                                                                    • Slide 206
                                                                                                                                                                                                                                    • Slide 207
                                                                                                                                                                                                                                    • Slide 208
                                                                                                                                                                                                                                    • Slide 209
                                                                                                                                                                                                                                    • Slide 210
                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                    • Slide 212
                                                                                                                                                                                                                                    • Slide 213
                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                    • Slide 215
                                                                                                                                                                                                                                    • Slide 216
                                                                                                                                                                                                                                    • Slide 217
                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                    • A challengehellip
                                                                                                                                                                                                                                    • Slide 222

                                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                      Block out distractions

                                                                                                                                                                                                                                      The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                                      - E Goldberg

                                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                      Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                      Get the reward

                                                                                                                                                                                                                                      Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                      Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                                      Instant gratification vs

                                                                                                                                                                                                                                      executive gratification

                                                                                                                                                                                                                                      A B C

                                                                                                                                                                                                                                      behaviorx

                                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                      takerdquordquo

                                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                      thathelliprdquo

                                                                                                                                                                                                                                      Match the Picture

                                                                                                                                                                                                                                      Distraction Delay Training

                                                                                                                                                                                                                                      Executive Estimates Training

                                                                                                                                                                                                                                      X

                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                      Asking two questionshellip

                                                                                                                                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                                                      this

                                                                                                                                                                                                                                      what

                                                                                                                                                                                                                                      I se

                                                                                                                                                                                                                                      t out

                                                                                                                                                                                                                                      to

                                                                                                                                                                                                                                      do

                                                                                                                                                                                                                                      bullYesbullYes

                                                                                                                                                                                                                                      bullNobullYes

                                                                                                                                                                                                                                      bullYesbullNo

                                                                                                                                                                                                                                      bullNobullNo

                                                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                                                      this

                                                                                                                                                                                                                                      what

                                                                                                                                                                                                                                      I se

                                                                                                                                                                                                                                      t out

                                                                                                                                                                                                                                      to

                                                                                                                                                                                                                                      do

                                                                                                                                                                                                                                      bullFunbullOn-task

                                                                                                                                                                                                                                      bullNot funbullOn-task

                                                                                                                                                                                                                                      bullFunbullNot on-task

                                                                                                                                                                                                                                      bullNot funbullNot on-task

                                                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                      Volkow et al 2004

                                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                                      Quarterly QI review

                                                                                                                                                                                                                                      The post-mortem

                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                      Yoga read

                                                                                                                                                                                                                                      Staff meeting

                                                                                                                                                                                                                                      Planningsession

                                                                                                                                                                                                                                      Phone calls

                                                                                                                                                                                                                                      billing

                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                      Learn French

                                                                                                                                                                                                                                      Stop smoking

                                                                                                                                                                                                                                      Be a better spouse

                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                                                                                                      DavidNowell

                                                                                                                                                                                                                                      • Slide 1
                                                                                                                                                                                                                                      • hellipa challenge
                                                                                                                                                                                                                                      • Slide 3
                                                                                                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                      • Slide 7
                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                      • Overview
                                                                                                                                                                                                                                      • This Dense Pudding
                                                                                                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                                                                      • Developmental considerations
                                                                                                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                      • Slide 17
                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                      • Slide 19
                                                                                                                                                                                                                                      • Strategies
                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                                                                      • Slide 23
                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                      • Slide 25
                                                                                                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                                                                                                      • Slide 27
                                                                                                                                                                                                                                      • Slide 28
                                                                                                                                                                                                                                      • Slide 29
                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                      • Slide 35
                                                                                                                                                                                                                                      • Strategies (2)
                                                                                                                                                                                                                                      • (C)APD
                                                                                                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                                                                                                      • Self-assessment
                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                      • Slide 42
                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                      • Core symptoms
                                                                                                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                      • Slide 53
                                                                                                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                                                                                                      • Slide 63
                                                                                                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                      • ADHD and girls
                                                                                                                                                                                                                                      • Slide 66
                                                                                                                                                                                                                                      • Slide 67
                                                                                                                                                                                                                                      • ADHD and women
                                                                                                                                                                                                                                      • Slide 69
                                                                                                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                      • The Executive Functions
                                                                                                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                                                                                                      • Slide 74
                                                                                                                                                                                                                                      • Slide 75
                                                                                                                                                                                                                                      • Appropriate expectations
                                                                                                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                      • Slide 84
                                                                                                                                                                                                                                      • Slide 85
                                                                                                                                                                                                                                      • Strategies (3)
                                                                                                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                                                                                                      • Behavioral Supports
                                                                                                                                                                                                                                      • Slide 89
                                                                                                                                                                                                                                      • Slide 90
                                                                                                                                                                                                                                      • Slide 91
                                                                                                                                                                                                                                      • Slide 92
                                                                                                                                                                                                                                      • Slide 93
                                                                                                                                                                                                                                      • Slide 94
                                                                                                                                                                                                                                      • Slide 95
                                                                                                                                                                                                                                      • Slide 96
                                                                                                                                                                                                                                      • Slide 97
                                                                                                                                                                                                                                      • Slide 98
                                                                                                                                                                                                                                      • Slide 99
                                                                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                                                                      • Slide 101
                                                                                                                                                                                                                                      • Slide 102
                                                                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                                                                      • Slide 106
                                                                                                                                                                                                                                      • Slide 107
                                                                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                                                                      • Slide 109
                                                                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                                                                      • Time Out
                                                                                                                                                                                                                                      • Token economy
                                                                                                                                                                                                                                      • Slide 113
                                                                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                                                                      • Slide 115
                                                                                                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                                                                                                      • Slide 117
                                                                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                                                                      • Metacognition
                                                                                                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                      • Slide 124
                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                      • Slide 128
                                                                                                                                                                                                                                      • Slide 129
                                                                                                                                                                                                                                      • Broaden and Build
                                                                                                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                      • Slide 141
                                                                                                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                      • Slide 146
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                      • Slide 149
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                      • Slide 152
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                      • Slide 154
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                      • Slide 157
                                                                                                                                                                                                                                      • Slide 158
                                                                                                                                                                                                                                      • Slide 159
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                      • Slide 162
                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                      • Slide 164
                                                                                                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                                                                                                      • Slide 166
                                                                                                                                                                                                                                      • Slide 167
                                                                                                                                                                                                                                      • Slide 168
                                                                                                                                                                                                                                      • Slide 169
                                                                                                                                                                                                                                      • Slide 170
                                                                                                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                      • Match the Picture
                                                                                                                                                                                                                                      • Slide 176
                                                                                                                                                                                                                                      • Slide 177
                                                                                                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                                                                                                      • Slide 179
                                                                                                                                                                                                                                      • Slide 180
                                                                                                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                                                                                                      • Learning Time
                                                                                                                                                                                                                                      • Learning Time (2)
                                                                                                                                                                                                                                      • Learning Time (3)
                                                                                                                                                                                                                                      • Slide 185
                                                                                                                                                                                                                                      • Slide 186
                                                                                                                                                                                                                                      • Learning Time (4)
                                                                                                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                                                                                                      • Slide 189
                                                                                                                                                                                                                                      • Slide 190
                                                                                                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                      • Slide 194
                                                                                                                                                                                                                                      • Slide 195
                                                                                                                                                                                                                                      • Slide 196
                                                                                                                                                                                                                                      • Slide 197
                                                                                                                                                                                                                                      • Slide 198
                                                                                                                                                                                                                                      • Slide 199
                                                                                                                                                                                                                                      • Slide 200
                                                                                                                                                                                                                                      • Slide 201
                                                                                                                                                                                                                                      • Quarterly QI review
                                                                                                                                                                                                                                      • The post-mortem
                                                                                                                                                                                                                                      • Slide 204
                                                                                                                                                                                                                                      • Slide 205
                                                                                                                                                                                                                                      • Slide 206
                                                                                                                                                                                                                                      • Slide 207
                                                                                                                                                                                                                                      • Slide 208
                                                                                                                                                                                                                                      • Slide 209
                                                                                                                                                                                                                                      • Slide 210
                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                      • Slide 212
                                                                                                                                                                                                                                      • Slide 213
                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                      • Slide 215
                                                                                                                                                                                                                                      • Slide 216
                                                                                                                                                                                                                                      • Slide 217
                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                      • A challengehellip
                                                                                                                                                                                                                                      • Slide 222

                                                                                                                                                                                                                                        The best defense against the manipulation of our attention is to determine for ourselves ndash in advance - how we want to invest it

                                                                                                                                                                                                                                        - E Goldberg

                                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                        Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                        Get the reward

                                                                                                                                                                                                                                        Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                        Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                                        Instant gratification vs

                                                                                                                                                                                                                                        executive gratification

                                                                                                                                                                                                                                        A B C

                                                                                                                                                                                                                                        behaviorx

                                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                                        bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                        bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                        bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                        takerdquordquo

                                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                        thathelliprdquo

                                                                                                                                                                                                                                        Match the Picture

                                                                                                                                                                                                                                        Distraction Delay Training

                                                                                                                                                                                                                                        Executive Estimates Training

                                                                                                                                                                                                                                        X

                                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                        Asking two questionshellip

                                                                                                                                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                                                        this

                                                                                                                                                                                                                                        what

                                                                                                                                                                                                                                        I se

                                                                                                                                                                                                                                        t out

                                                                                                                                                                                                                                        to

                                                                                                                                                                                                                                        do

                                                                                                                                                                                                                                        bullYesbullYes

                                                                                                                                                                                                                                        bullNobullYes

                                                                                                                                                                                                                                        bullYesbullNo

                                                                                                                                                                                                                                        bullNobullNo

                                                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                                                        this

                                                                                                                                                                                                                                        what

                                                                                                                                                                                                                                        I se

                                                                                                                                                                                                                                        t out

                                                                                                                                                                                                                                        to

                                                                                                                                                                                                                                        do

                                                                                                                                                                                                                                        bullFunbullOn-task

                                                                                                                                                                                                                                        bullNot funbullOn-task

                                                                                                                                                                                                                                        bullFunbullNot on-task

                                                                                                                                                                                                                                        bullNot funbullNot on-task

                                                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                        Volkow et al 2004

                                                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                                                        Quarterly QI review

                                                                                                                                                                                                                                        The post-mortem

                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                        Yoga read

                                                                                                                                                                                                                                        Staff meeting

                                                                                                                                                                                                                                        Planningsession

                                                                                                                                                                                                                                        Phone calls

                                                                                                                                                                                                                                        billing

                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                        Learn French

                                                                                                                                                                                                                                        Stop smoking

                                                                                                                                                                                                                                        Be a better spouse

                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                                                                                                        DavidNowell

                                                                                                                                                                                                                                        • Slide 1
                                                                                                                                                                                                                                        • hellipa challenge
                                                                                                                                                                                                                                        • Slide 3
                                                                                                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                        • Slide 7
                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                        • Overview
                                                                                                                                                                                                                                        • This Dense Pudding
                                                                                                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                                                                        • Developmental considerations
                                                                                                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                        • Slide 17
                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                        • Slide 19
                                                                                                                                                                                                                                        • Strategies
                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                                                                        • Slide 23
                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                        • Slide 25
                                                                                                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                                                                                                        • Slide 27
                                                                                                                                                                                                                                        • Slide 28
                                                                                                                                                                                                                                        • Slide 29
                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                        • Slide 35
                                                                                                                                                                                                                                        • Strategies (2)
                                                                                                                                                                                                                                        • (C)APD
                                                                                                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                                                                                                        • Self-assessment
                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                        • Slide 42
                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                        • Core symptoms
                                                                                                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                        • Slide 53
                                                                                                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                                                                                                        • Slide 63
                                                                                                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                        • ADHD and girls
                                                                                                                                                                                                                                        • Slide 66
                                                                                                                                                                                                                                        • Slide 67
                                                                                                                                                                                                                                        • ADHD and women
                                                                                                                                                                                                                                        • Slide 69
                                                                                                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                        • The Executive Functions
                                                                                                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                                                                                                        • Slide 74
                                                                                                                                                                                                                                        • Slide 75
                                                                                                                                                                                                                                        • Appropriate expectations
                                                                                                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                        • Slide 84
                                                                                                                                                                                                                                        • Slide 85
                                                                                                                                                                                                                                        • Strategies (3)
                                                                                                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                                                                                                        • Behavioral Supports
                                                                                                                                                                                                                                        • Slide 89
                                                                                                                                                                                                                                        • Slide 90
                                                                                                                                                                                                                                        • Slide 91
                                                                                                                                                                                                                                        • Slide 92
                                                                                                                                                                                                                                        • Slide 93
                                                                                                                                                                                                                                        • Slide 94
                                                                                                                                                                                                                                        • Slide 95
                                                                                                                                                                                                                                        • Slide 96
                                                                                                                                                                                                                                        • Slide 97
                                                                                                                                                                                                                                        • Slide 98
                                                                                                                                                                                                                                        • Slide 99
                                                                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                                                                        • Slide 101
                                                                                                                                                                                                                                        • Slide 102
                                                                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                                                                        • Slide 106
                                                                                                                                                                                                                                        • Slide 107
                                                                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                                                                        • Slide 109
                                                                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                                                                        • Time Out
                                                                                                                                                                                                                                        • Token economy
                                                                                                                                                                                                                                        • Slide 113
                                                                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                                                                        • Slide 115
                                                                                                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                                                                                                        • Slide 117
                                                                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                                                                        • Metacognition
                                                                                                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                        • Slide 124
                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                        • Slide 128
                                                                                                                                                                                                                                        • Slide 129
                                                                                                                                                                                                                                        • Broaden and Build
                                                                                                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                        • Slide 141
                                                                                                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                        • Slide 146
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                        • Slide 149
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                        • Slide 152
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                        • Slide 154
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                        • Slide 157
                                                                                                                                                                                                                                        • Slide 158
                                                                                                                                                                                                                                        • Slide 159
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                        • Slide 162
                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                        • Slide 164
                                                                                                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                                                                                                        • Slide 166
                                                                                                                                                                                                                                        • Slide 167
                                                                                                                                                                                                                                        • Slide 168
                                                                                                                                                                                                                                        • Slide 169
                                                                                                                                                                                                                                        • Slide 170
                                                                                                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                        • Match the Picture
                                                                                                                                                                                                                                        • Slide 176
                                                                                                                                                                                                                                        • Slide 177
                                                                                                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                                                                                                        • Slide 179
                                                                                                                                                                                                                                        • Slide 180
                                                                                                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                                                                                                        • Learning Time
                                                                                                                                                                                                                                        • Learning Time (2)
                                                                                                                                                                                                                                        • Learning Time (3)
                                                                                                                                                                                                                                        • Slide 185
                                                                                                                                                                                                                                        • Slide 186
                                                                                                                                                                                                                                        • Learning Time (4)
                                                                                                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                                                                                                        • Slide 189
                                                                                                                                                                                                                                        • Slide 190
                                                                                                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                        • Slide 194
                                                                                                                                                                                                                                        • Slide 195
                                                                                                                                                                                                                                        • Slide 196
                                                                                                                                                                                                                                        • Slide 197
                                                                                                                                                                                                                                        • Slide 198
                                                                                                                                                                                                                                        • Slide 199
                                                                                                                                                                                                                                        • Slide 200
                                                                                                                                                                                                                                        • Slide 201
                                                                                                                                                                                                                                        • Quarterly QI review
                                                                                                                                                                                                                                        • The post-mortem
                                                                                                                                                                                                                                        • Slide 204
                                                                                                                                                                                                                                        • Slide 205
                                                                                                                                                                                                                                        • Slide 206
                                                                                                                                                                                                                                        • Slide 207
                                                                                                                                                                                                                                        • Slide 208
                                                                                                                                                                                                                                        • Slide 209
                                                                                                                                                                                                                                        • Slide 210
                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                        • Slide 212
                                                                                                                                                                                                                                        • Slide 213
                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                        • Slide 215
                                                                                                                                                                                                                                        • Slide 216
                                                                                                                                                                                                                                        • Slide 217
                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                        • A challengehellip
                                                                                                                                                                                                                                        • Slide 222

                                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                          Block out distractions Field dependent (sensitive to novelty) Saliency Working memory Easily discouraged

                                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                          Get the reward

                                                                                                                                                                                                                                          Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                          Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                                          Instant gratification vs

                                                                                                                                                                                                                                          executive gratification

                                                                                                                                                                                                                                          A B C

                                                                                                                                                                                                                                          behaviorx

                                                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                                                          bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                          bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                          bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                          takerdquordquo

                                                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                                                          bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                          bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                          bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                          bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                          thathelliprdquo

                                                                                                                                                                                                                                          Match the Picture

                                                                                                                                                                                                                                          Distraction Delay Training

                                                                                                                                                                                                                                          Executive Estimates Training

                                                                                                                                                                                                                                          X

                                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                          Asking two questionshellip

                                                                                                                                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                                                          this

                                                                                                                                                                                                                                          what

                                                                                                                                                                                                                                          I se

                                                                                                                                                                                                                                          t out

                                                                                                                                                                                                                                          to

                                                                                                                                                                                                                                          do

                                                                                                                                                                                                                                          bullYesbullYes

                                                                                                                                                                                                                                          bullNobullYes

                                                                                                                                                                                                                                          bullYesbullNo

                                                                                                                                                                                                                                          bullNobullNo

                                                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                                                          this

                                                                                                                                                                                                                                          what

                                                                                                                                                                                                                                          I se

                                                                                                                                                                                                                                          t out

                                                                                                                                                                                                                                          to

                                                                                                                                                                                                                                          do

                                                                                                                                                                                                                                          bullFunbullOn-task

                                                                                                                                                                                                                                          bullNot funbullOn-task

                                                                                                                                                                                                                                          bullFunbullNot on-task

                                                                                                                                                                                                                                          bullNot funbullNot on-task

                                                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                          Volkow et al 2004

                                                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                                                          Quarterly QI review

                                                                                                                                                                                                                                          The post-mortem

                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                          Yoga read

                                                                                                                                                                                                                                          Staff meeting

                                                                                                                                                                                                                                          Planningsession

                                                                                                                                                                                                                                          Phone calls

                                                                                                                                                                                                                                          billing

                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                          Learn French

                                                                                                                                                                                                                                          Stop smoking

                                                                                                                                                                                                                                          Be a better spouse

                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                                                                                                          DavidNowell

                                                                                                                                                                                                                                          • Slide 1
                                                                                                                                                                                                                                          • hellipa challenge
                                                                                                                                                                                                                                          • Slide 3
                                                                                                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                          • Slide 7
                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                          • Overview
                                                                                                                                                                                                                                          • This Dense Pudding
                                                                                                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                                                                          • Developmental considerations
                                                                                                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                          • Slide 17
                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                          • Slide 19
                                                                                                                                                                                                                                          • Strategies
                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                                                                          • Slide 23
                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                          • Slide 25
                                                                                                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                                                                                                          • Slide 27
                                                                                                                                                                                                                                          • Slide 28
                                                                                                                                                                                                                                          • Slide 29
                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                          • Slide 35
                                                                                                                                                                                                                                          • Strategies (2)
                                                                                                                                                                                                                                          • (C)APD
                                                                                                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                                                                                                          • Self-assessment
                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                          • Slide 42
                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                          • Core symptoms
                                                                                                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                          • Slide 53
                                                                                                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                                                                                                          • Slide 63
                                                                                                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                          • ADHD and girls
                                                                                                                                                                                                                                          • Slide 66
                                                                                                                                                                                                                                          • Slide 67
                                                                                                                                                                                                                                          • ADHD and women
                                                                                                                                                                                                                                          • Slide 69
                                                                                                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                          • The Executive Functions
                                                                                                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                                                                                                          • Slide 74
                                                                                                                                                                                                                                          • Slide 75
                                                                                                                                                                                                                                          • Appropriate expectations
                                                                                                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                          • Slide 84
                                                                                                                                                                                                                                          • Slide 85
                                                                                                                                                                                                                                          • Strategies (3)
                                                                                                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                                                                                                          • Behavioral Supports
                                                                                                                                                                                                                                          • Slide 89
                                                                                                                                                                                                                                          • Slide 90
                                                                                                                                                                                                                                          • Slide 91
                                                                                                                                                                                                                                          • Slide 92
                                                                                                                                                                                                                                          • Slide 93
                                                                                                                                                                                                                                          • Slide 94
                                                                                                                                                                                                                                          • Slide 95
                                                                                                                                                                                                                                          • Slide 96
                                                                                                                                                                                                                                          • Slide 97
                                                                                                                                                                                                                                          • Slide 98
                                                                                                                                                                                                                                          • Slide 99
                                                                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                                                                          • Slide 101
                                                                                                                                                                                                                                          • Slide 102
                                                                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                                                                          • Slide 106
                                                                                                                                                                                                                                          • Slide 107
                                                                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                                                                          • Slide 109
                                                                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                                                                          • Time Out
                                                                                                                                                                                                                                          • Token economy
                                                                                                                                                                                                                                          • Slide 113
                                                                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                                                                          • Slide 115
                                                                                                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                                                                                                          • Slide 117
                                                                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                                                                          • Metacognition
                                                                                                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                          • Slide 124
                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                          • Slide 128
                                                                                                                                                                                                                                          • Slide 129
                                                                                                                                                                                                                                          • Broaden and Build
                                                                                                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                          • Slide 141
                                                                                                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                          • Slide 146
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                          • Slide 149
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                          • Slide 152
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                          • Slide 154
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                          • Slide 157
                                                                                                                                                                                                                                          • Slide 158
                                                                                                                                                                                                                                          • Slide 159
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                          • Slide 162
                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                          • Slide 164
                                                                                                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                                                                                                          • Slide 166
                                                                                                                                                                                                                                          • Slide 167
                                                                                                                                                                                                                                          • Slide 168
                                                                                                                                                                                                                                          • Slide 169
                                                                                                                                                                                                                                          • Slide 170
                                                                                                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                          • Match the Picture
                                                                                                                                                                                                                                          • Slide 176
                                                                                                                                                                                                                                          • Slide 177
                                                                                                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                                                                                                          • Slide 179
                                                                                                                                                                                                                                          • Slide 180
                                                                                                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                                                                                                          • Learning Time
                                                                                                                                                                                                                                          • Learning Time (2)
                                                                                                                                                                                                                                          • Learning Time (3)
                                                                                                                                                                                                                                          • Slide 185
                                                                                                                                                                                                                                          • Slide 186
                                                                                                                                                                                                                                          • Learning Time (4)
                                                                                                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                                                                                                          • Slide 189
                                                                                                                                                                                                                                          • Slide 190
                                                                                                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                          • Slide 194
                                                                                                                                                                                                                                          • Slide 195
                                                                                                                                                                                                                                          • Slide 196
                                                                                                                                                                                                                                          • Slide 197
                                                                                                                                                                                                                                          • Slide 198
                                                                                                                                                                                                                                          • Slide 199
                                                                                                                                                                                                                                          • Slide 200
                                                                                                                                                                                                                                          • Slide 201
                                                                                                                                                                                                                                          • Quarterly QI review
                                                                                                                                                                                                                                          • The post-mortem
                                                                                                                                                                                                                                          • Slide 204
                                                                                                                                                                                                                                          • Slide 205
                                                                                                                                                                                                                                          • Slide 206
                                                                                                                                                                                                                                          • Slide 207
                                                                                                                                                                                                                                          • Slide 208
                                                                                                                                                                                                                                          • Slide 209
                                                                                                                                                                                                                                          • Slide 210
                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                          • Slide 212
                                                                                                                                                                                                                                          • Slide 213
                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                          • Slide 215
                                                                                                                                                                                                                                          • Slide 216
                                                                                                                                                                                                                                          • Slide 217
                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                          • A challengehellip
                                                                                                                                                                                                                                          • Slide 222

                                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                            Get the reward

                                                                                                                                                                                                                                            Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                            Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                                            Instant gratification vs

                                                                                                                                                                                                                                            executive gratification

                                                                                                                                                                                                                                            A B C

                                                                                                                                                                                                                                            behaviorx

                                                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                                                            bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                            bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                            bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                            takerdquordquo

                                                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                                                            bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                            bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                            bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                            bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                            Self-Talk Proficiency

                                                                                                                                                                                                                                            bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                            bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                            differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                            thathelliprdquo

                                                                                                                                                                                                                                            Match the Picture

                                                                                                                                                                                                                                            Distraction Delay Training

                                                                                                                                                                                                                                            Executive Estimates Training

                                                                                                                                                                                                                                            X

                                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                            Asking two questionshellip

                                                                                                                                                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                                                            this

                                                                                                                                                                                                                                            what

                                                                                                                                                                                                                                            I se

                                                                                                                                                                                                                                            t out

                                                                                                                                                                                                                                            to

                                                                                                                                                                                                                                            do

                                                                                                                                                                                                                                            bullYesbullYes

                                                                                                                                                                                                                                            bullNobullYes

                                                                                                                                                                                                                                            bullYesbullNo

                                                                                                                                                                                                                                            bullNobullNo

                                                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                                                            this

                                                                                                                                                                                                                                            what

                                                                                                                                                                                                                                            I se

                                                                                                                                                                                                                                            t out

                                                                                                                                                                                                                                            to

                                                                                                                                                                                                                                            do

                                                                                                                                                                                                                                            bullFunbullOn-task

                                                                                                                                                                                                                                            bullNot funbullOn-task

                                                                                                                                                                                                                                            bullFunbullNot on-task

                                                                                                                                                                                                                                            bullNot funbullNot on-task

                                                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                            Volkow et al 2004

                                                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                                                            Quarterly QI review

                                                                                                                                                                                                                                            The post-mortem

                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                            Yoga read

                                                                                                                                                                                                                                            Staff meeting

                                                                                                                                                                                                                                            Planningsession

                                                                                                                                                                                                                                            Phone calls

                                                                                                                                                                                                                                            billing

                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                            Learn French

                                                                                                                                                                                                                                            Stop smoking

                                                                                                                                                                                                                                            Be a better spouse

                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                                                                                                            DavidNowell

                                                                                                                                                                                                                                            • Slide 1
                                                                                                                                                                                                                                            • hellipa challenge
                                                                                                                                                                                                                                            • Slide 3
                                                                                                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                            • Slide 7
                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                            • Overview
                                                                                                                                                                                                                                            • This Dense Pudding
                                                                                                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                                                                            • Developmental considerations
                                                                                                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                            • Slide 17
                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                            • Slide 19
                                                                                                                                                                                                                                            • Strategies
                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                                                                            • Slide 23
                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                            • Slide 25
                                                                                                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                                                                                                            • Slide 27
                                                                                                                                                                                                                                            • Slide 28
                                                                                                                                                                                                                                            • Slide 29
                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                            • Slide 35
                                                                                                                                                                                                                                            • Strategies (2)
                                                                                                                                                                                                                                            • (C)APD
                                                                                                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                                                                                                            • Self-assessment
                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                            • Slide 42
                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                            • Core symptoms
                                                                                                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                            • Slide 53
                                                                                                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                                                                                                            • Slide 63
                                                                                                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                            • ADHD and girls
                                                                                                                                                                                                                                            • Slide 66
                                                                                                                                                                                                                                            • Slide 67
                                                                                                                                                                                                                                            • ADHD and women
                                                                                                                                                                                                                                            • Slide 69
                                                                                                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                            • The Executive Functions
                                                                                                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                                                                                                            • Slide 74
                                                                                                                                                                                                                                            • Slide 75
                                                                                                                                                                                                                                            • Appropriate expectations
                                                                                                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                            • Slide 84
                                                                                                                                                                                                                                            • Slide 85
                                                                                                                                                                                                                                            • Strategies (3)
                                                                                                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                                                                                                            • Behavioral Supports
                                                                                                                                                                                                                                            • Slide 89
                                                                                                                                                                                                                                            • Slide 90
                                                                                                                                                                                                                                            • Slide 91
                                                                                                                                                                                                                                            • Slide 92
                                                                                                                                                                                                                                            • Slide 93
                                                                                                                                                                                                                                            • Slide 94
                                                                                                                                                                                                                                            • Slide 95
                                                                                                                                                                                                                                            • Slide 96
                                                                                                                                                                                                                                            • Slide 97
                                                                                                                                                                                                                                            • Slide 98
                                                                                                                                                                                                                                            • Slide 99
                                                                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                                                                            • Slide 101
                                                                                                                                                                                                                                            • Slide 102
                                                                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                                                                            • Slide 106
                                                                                                                                                                                                                                            • Slide 107
                                                                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                                                                            • Slide 109
                                                                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                                                                            • Time Out
                                                                                                                                                                                                                                            • Token economy
                                                                                                                                                                                                                                            • Slide 113
                                                                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                                                                            • Slide 115
                                                                                                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                                                                                                            • Slide 117
                                                                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                                                                            • Metacognition
                                                                                                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                            • Slide 124
                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                            • Slide 128
                                                                                                                                                                                                                                            • Slide 129
                                                                                                                                                                                                                                            • Broaden and Build
                                                                                                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                            • Slide 141
                                                                                                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                            • Slide 146
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                            • Slide 149
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                            • Slide 152
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                            • Slide 154
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                            • Slide 157
                                                                                                                                                                                                                                            • Slide 158
                                                                                                                                                                                                                                            • Slide 159
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                            • Slide 162
                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                            • Slide 164
                                                                                                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                                                                                                            • Slide 166
                                                                                                                                                                                                                                            • Slide 167
                                                                                                                                                                                                                                            • Slide 168
                                                                                                                                                                                                                                            • Slide 169
                                                                                                                                                                                                                                            • Slide 170
                                                                                                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                            • Match the Picture
                                                                                                                                                                                                                                            • Slide 176
                                                                                                                                                                                                                                            • Slide 177
                                                                                                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                                                                                                            • Slide 179
                                                                                                                                                                                                                                            • Slide 180
                                                                                                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                                                                                                            • Learning Time
                                                                                                                                                                                                                                            • Learning Time (2)
                                                                                                                                                                                                                                            • Learning Time (3)
                                                                                                                                                                                                                                            • Slide 185
                                                                                                                                                                                                                                            • Slide 186
                                                                                                                                                                                                                                            • Learning Time (4)
                                                                                                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                                                                                                            • Slide 189
                                                                                                                                                                                                                                            • Slide 190
                                                                                                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                            • Slide 194
                                                                                                                                                                                                                                            • Slide 195
                                                                                                                                                                                                                                            • Slide 196
                                                                                                                                                                                                                                            • Slide 197
                                                                                                                                                                                                                                            • Slide 198
                                                                                                                                                                                                                                            • Slide 199
                                                                                                                                                                                                                                            • Slide 200
                                                                                                                                                                                                                                            • Slide 201
                                                                                                                                                                                                                                            • Quarterly QI review
                                                                                                                                                                                                                                            • The post-mortem
                                                                                                                                                                                                                                            • Slide 204
                                                                                                                                                                                                                                            • Slide 205
                                                                                                                                                                                                                                            • Slide 206
                                                                                                                                                                                                                                            • Slide 207
                                                                                                                                                                                                                                            • Slide 208
                                                                                                                                                                                                                                            • Slide 209
                                                                                                                                                                                                                                            • Slide 210
                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                            • Slide 212
                                                                                                                                                                                                                                            • Slide 213
                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                            • Slide 215
                                                                                                                                                                                                                                            • Slide 216
                                                                                                                                                                                                                                            • Slide 217
                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                            • A challengehellip
                                                                                                                                                                                                                                            • Slide 222

                                                                                                                                                                                                                                              Ways the reward-and-planning system can go wrong

                                                                                                                                                                                                                                              Get the reward Satisfaction control Picked wrong task Picked wrong goal (ldquostaterdquo) Sociopathy

                                                                                                                                                                                                                                              Instant gratification vs

                                                                                                                                                                                                                                              executive gratification

                                                                                                                                                                                                                                              A B C

                                                                                                                                                                                                                                              behaviorx

                                                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                                                              bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                              bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                              bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                              takerdquordquo

                                                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                                                              bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                              bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                              bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                              bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                              Self-Talk Proficiency

                                                                                                                                                                                                                                              bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                              bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                              differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                              thathelliprdquo

                                                                                                                                                                                                                                              Match the Picture

                                                                                                                                                                                                                                              Distraction Delay Training

                                                                                                                                                                                                                                              Executive Estimates Training

                                                                                                                                                                                                                                              X

                                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                              Asking two questionshellip

                                                                                                                                                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                                                                              this

                                                                                                                                                                                                                                              what

                                                                                                                                                                                                                                              I se

                                                                                                                                                                                                                                              t out

                                                                                                                                                                                                                                              to

                                                                                                                                                                                                                                              do

                                                                                                                                                                                                                                              bullYesbullYes

                                                                                                                                                                                                                                              bullNobullYes

                                                                                                                                                                                                                                              bullYesbullNo

                                                                                                                                                                                                                                              bullNobullNo

                                                                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                                                                              this

                                                                                                                                                                                                                                              what

                                                                                                                                                                                                                                              I se

                                                                                                                                                                                                                                              t out

                                                                                                                                                                                                                                              to

                                                                                                                                                                                                                                              do

                                                                                                                                                                                                                                              bullFunbullOn-task

                                                                                                                                                                                                                                              bullNot funbullOn-task

                                                                                                                                                                                                                                              bullFunbullNot on-task

                                                                                                                                                                                                                                              bullNot funbullNot on-task

                                                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                              Volkow et al 2004

                                                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                                                              Quarterly QI review

                                                                                                                                                                                                                                              The post-mortem

                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                              Yoga read

                                                                                                                                                                                                                                              Staff meeting

                                                                                                                                                                                                                                              Planningsession

                                                                                                                                                                                                                                              Phone calls

                                                                                                                                                                                                                                              billing

                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                              Learn French

                                                                                                                                                                                                                                              Stop smoking

                                                                                                                                                                                                                                              Be a better spouse

                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                                                                                                              DavidNowell

                                                                                                                                                                                                                                              • Slide 1
                                                                                                                                                                                                                                              • hellipa challenge
                                                                                                                                                                                                                                              • Slide 3
                                                                                                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                              • Slide 7
                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                              • Overview
                                                                                                                                                                                                                                              • This Dense Pudding
                                                                                                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                                                                              • Developmental considerations
                                                                                                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                              • Slide 17
                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                              • Slide 19
                                                                                                                                                                                                                                              • Strategies
                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                                                                              • Slide 23
                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                              • Slide 25
                                                                                                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                                                                                                              • Slide 27
                                                                                                                                                                                                                                              • Slide 28
                                                                                                                                                                                                                                              • Slide 29
                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                              • Slide 35
                                                                                                                                                                                                                                              • Strategies (2)
                                                                                                                                                                                                                                              • (C)APD
                                                                                                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                                                                                                              • Self-assessment
                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                              • Slide 42
                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                              • Core symptoms
                                                                                                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                              • Slide 53
                                                                                                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                                                                                                              • Slide 63
                                                                                                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                              • ADHD and girls
                                                                                                                                                                                                                                              • Slide 66
                                                                                                                                                                                                                                              • Slide 67
                                                                                                                                                                                                                                              • ADHD and women
                                                                                                                                                                                                                                              • Slide 69
                                                                                                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                              • The Executive Functions
                                                                                                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                                                                                                              • Slide 74
                                                                                                                                                                                                                                              • Slide 75
                                                                                                                                                                                                                                              • Appropriate expectations
                                                                                                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                              • Slide 84
                                                                                                                                                                                                                                              • Slide 85
                                                                                                                                                                                                                                              • Strategies (3)
                                                                                                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                                                                                                              • Behavioral Supports
                                                                                                                                                                                                                                              • Slide 89
                                                                                                                                                                                                                                              • Slide 90
                                                                                                                                                                                                                                              • Slide 91
                                                                                                                                                                                                                                              • Slide 92
                                                                                                                                                                                                                                              • Slide 93
                                                                                                                                                                                                                                              • Slide 94
                                                                                                                                                                                                                                              • Slide 95
                                                                                                                                                                                                                                              • Slide 96
                                                                                                                                                                                                                                              • Slide 97
                                                                                                                                                                                                                                              • Slide 98
                                                                                                                                                                                                                                              • Slide 99
                                                                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                                                                              • Slide 101
                                                                                                                                                                                                                                              • Slide 102
                                                                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                                                                              • Slide 106
                                                                                                                                                                                                                                              • Slide 107
                                                                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                                                                              • Slide 109
                                                                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                                                                              • Time Out
                                                                                                                                                                                                                                              • Token economy
                                                                                                                                                                                                                                              • Slide 113
                                                                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                                                                              • Slide 115
                                                                                                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                                                                                                              • Slide 117
                                                                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                                                                              • Metacognition
                                                                                                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                              • Slide 124
                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                              • Slide 128
                                                                                                                                                                                                                                              • Slide 129
                                                                                                                                                                                                                                              • Broaden and Build
                                                                                                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                              • Slide 141
                                                                                                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                              • Slide 146
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                              • Slide 149
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                              • Slide 152
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                              • Slide 154
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                              • Slide 157
                                                                                                                                                                                                                                              • Slide 158
                                                                                                                                                                                                                                              • Slide 159
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                              • Slide 162
                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                              • Slide 164
                                                                                                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                                                                                                              • Slide 166
                                                                                                                                                                                                                                              • Slide 167
                                                                                                                                                                                                                                              • Slide 168
                                                                                                                                                                                                                                              • Slide 169
                                                                                                                                                                                                                                              • Slide 170
                                                                                                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                              • Match the Picture
                                                                                                                                                                                                                                              • Slide 176
                                                                                                                                                                                                                                              • Slide 177
                                                                                                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                                                                                                              • Slide 179
                                                                                                                                                                                                                                              • Slide 180
                                                                                                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                                                                                                              • Learning Time
                                                                                                                                                                                                                                              • Learning Time (2)
                                                                                                                                                                                                                                              • Learning Time (3)
                                                                                                                                                                                                                                              • Slide 185
                                                                                                                                                                                                                                              • Slide 186
                                                                                                                                                                                                                                              • Learning Time (4)
                                                                                                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                                                                                                              • Slide 189
                                                                                                                                                                                                                                              • Slide 190
                                                                                                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                              • Slide 194
                                                                                                                                                                                                                                              • Slide 195
                                                                                                                                                                                                                                              • Slide 196
                                                                                                                                                                                                                                              • Slide 197
                                                                                                                                                                                                                                              • Slide 198
                                                                                                                                                                                                                                              • Slide 199
                                                                                                                                                                                                                                              • Slide 200
                                                                                                                                                                                                                                              • Slide 201
                                                                                                                                                                                                                                              • Quarterly QI review
                                                                                                                                                                                                                                              • The post-mortem
                                                                                                                                                                                                                                              • Slide 204
                                                                                                                                                                                                                                              • Slide 205
                                                                                                                                                                                                                                              • Slide 206
                                                                                                                                                                                                                                              • Slide 207
                                                                                                                                                                                                                                              • Slide 208
                                                                                                                                                                                                                                              • Slide 209
                                                                                                                                                                                                                                              • Slide 210
                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                              • Slide 212
                                                                                                                                                                                                                                              • Slide 213
                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                              • Slide 215
                                                                                                                                                                                                                                              • Slide 216
                                                                                                                                                                                                                                              • Slide 217
                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                              • A challengehellip
                                                                                                                                                                                                                                              • Slide 222

                                                                                                                                                                                                                                                Instant gratification vs

                                                                                                                                                                                                                                                executive gratification

                                                                                                                                                                                                                                                A B C

                                                                                                                                                                                                                                                behaviorx

                                                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                                                bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                                bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                                bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                                takerdquordquo

                                                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                                                bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                                bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                                bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                                bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                                Self-Talk Proficiency

                                                                                                                                                                                                                                                bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                                bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                                differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                                thathelliprdquo

                                                                                                                                                                                                                                                Match the Picture

                                                                                                                                                                                                                                                Distraction Delay Training

                                                                                                                                                                                                                                                Executive Estimates Training

                                                                                                                                                                                                                                                X

                                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                Asking two questionshellip

                                                                                                                                                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                                                                this

                                                                                                                                                                                                                                                what

                                                                                                                                                                                                                                                I se

                                                                                                                                                                                                                                                t out

                                                                                                                                                                                                                                                to

                                                                                                                                                                                                                                                do

                                                                                                                                                                                                                                                bullYesbullYes

                                                                                                                                                                                                                                                bullNobullYes

                                                                                                                                                                                                                                                bullYesbullNo

                                                                                                                                                                                                                                                bullNobullNo

                                                                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                                                                this

                                                                                                                                                                                                                                                what

                                                                                                                                                                                                                                                I se

                                                                                                                                                                                                                                                t out

                                                                                                                                                                                                                                                to

                                                                                                                                                                                                                                                do

                                                                                                                                                                                                                                                bullFunbullOn-task

                                                                                                                                                                                                                                                bullNot funbullOn-task

                                                                                                                                                                                                                                                bullFunbullNot on-task

                                                                                                                                                                                                                                                bullNot funbullNot on-task

                                                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                Volkow et al 2004

                                                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                                                Quarterly QI review

                                                                                                                                                                                                                                                The post-mortem

                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                Yoga read

                                                                                                                                                                                                                                                Staff meeting

                                                                                                                                                                                                                                                Planningsession

                                                                                                                                                                                                                                                Phone calls

                                                                                                                                                                                                                                                billing

                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                Learn French

                                                                                                                                                                                                                                                Stop smoking

                                                                                                                                                                                                                                                Be a better spouse

                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                                                                                                DavidNowell

                                                                                                                                                                                                                                                • Slide 1
                                                                                                                                                                                                                                                • hellipa challenge
                                                                                                                                                                                                                                                • Slide 3
                                                                                                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                • Slide 7
                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                • Overview
                                                                                                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                                                                • Developmental considerations
                                                                                                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                • Slide 17
                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                • Slide 19
                                                                                                                                                                                                                                                • Strategies
                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                                                                • Slide 23
                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                • Slide 25
                                                                                                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                • Slide 27
                                                                                                                                                                                                                                                • Slide 28
                                                                                                                                                                                                                                                • Slide 29
                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                • Slide 35
                                                                                                                                                                                                                                                • Strategies (2)
                                                                                                                                                                                                                                                • (C)APD
                                                                                                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                                                                                                • Self-assessment
                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                • Slide 42
                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                • Core symptoms
                                                                                                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                • Slide 53
                                                                                                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                                                                                                • Slide 63
                                                                                                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                • ADHD and girls
                                                                                                                                                                                                                                                • Slide 66
                                                                                                                                                                                                                                                • Slide 67
                                                                                                                                                                                                                                                • ADHD and women
                                                                                                                                                                                                                                                • Slide 69
                                                                                                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                • The Executive Functions
                                                                                                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                                                                                                • Slide 74
                                                                                                                                                                                                                                                • Slide 75
                                                                                                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                • Slide 84
                                                                                                                                                                                                                                                • Slide 85
                                                                                                                                                                                                                                                • Strategies (3)
                                                                                                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                                                                                                • Slide 89
                                                                                                                                                                                                                                                • Slide 90
                                                                                                                                                                                                                                                • Slide 91
                                                                                                                                                                                                                                                • Slide 92
                                                                                                                                                                                                                                                • Slide 93
                                                                                                                                                                                                                                                • Slide 94
                                                                                                                                                                                                                                                • Slide 95
                                                                                                                                                                                                                                                • Slide 96
                                                                                                                                                                                                                                                • Slide 97
                                                                                                                                                                                                                                                • Slide 98
                                                                                                                                                                                                                                                • Slide 99
                                                                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                                                                • Slide 101
                                                                                                                                                                                                                                                • Slide 102
                                                                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                                                                • Slide 106
                                                                                                                                                                                                                                                • Slide 107
                                                                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                                                                • Slide 109
                                                                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                                                                • Time Out
                                                                                                                                                                                                                                                • Token economy
                                                                                                                                                                                                                                                • Slide 113
                                                                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                                                                • Slide 115
                                                                                                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                                                                                                • Slide 117
                                                                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                                                                • Metacognition
                                                                                                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                • Slide 124
                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                • Slide 128
                                                                                                                                                                                                                                                • Slide 129
                                                                                                                                                                                                                                                • Broaden and Build
                                                                                                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                • Slide 141
                                                                                                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                • Slide 146
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                • Slide 149
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                • Slide 152
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                • Slide 154
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                • Slide 157
                                                                                                                                                                                                                                                • Slide 158
                                                                                                                                                                                                                                                • Slide 159
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                • Slide 162
                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                • Slide 164
                                                                                                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                • Slide 166
                                                                                                                                                                                                                                                • Slide 167
                                                                                                                                                                                                                                                • Slide 168
                                                                                                                                                                                                                                                • Slide 169
                                                                                                                                                                                                                                                • Slide 170
                                                                                                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                • Match the Picture
                                                                                                                                                                                                                                                • Slide 176
                                                                                                                                                                                                                                                • Slide 177
                                                                                                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                                                                                                • Slide 179
                                                                                                                                                                                                                                                • Slide 180
                                                                                                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                                                                                                • Learning Time
                                                                                                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                                                                                                • Slide 185
                                                                                                                                                                                                                                                • Slide 186
                                                                                                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                                                                                                • Slide 189
                                                                                                                                                                                                                                                • Slide 190
                                                                                                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                • Slide 194
                                                                                                                                                                                                                                                • Slide 195
                                                                                                                                                                                                                                                • Slide 196
                                                                                                                                                                                                                                                • Slide 197
                                                                                                                                                                                                                                                • Slide 198
                                                                                                                                                                                                                                                • Slide 199
                                                                                                                                                                                                                                                • Slide 200
                                                                                                                                                                                                                                                • Slide 201
                                                                                                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                                                                                                • The post-mortem
                                                                                                                                                                                                                                                • Slide 204
                                                                                                                                                                                                                                                • Slide 205
                                                                                                                                                                                                                                                • Slide 206
                                                                                                                                                                                                                                                • Slide 207
                                                                                                                                                                                                                                                • Slide 208
                                                                                                                                                                                                                                                • Slide 209
                                                                                                                                                                                                                                                • Slide 210
                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                • Slide 212
                                                                                                                                                                                                                                                • Slide 213
                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                • Slide 215
                                                                                                                                                                                                                                                • Slide 216
                                                                                                                                                                                                                                                • Slide 217
                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                • A challengehellip
                                                                                                                                                                                                                                                • Slide 222

                                                                                                                                                                                                                                                  A B C

                                                                                                                                                                                                                                                  behaviorx

                                                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                                                  bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                                  bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                                  bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                                  takerdquordquo

                                                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                                                  bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                                  bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                                  bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                                  bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                                  Self-Talk Proficiency

                                                                                                                                                                                                                                                  bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                                  bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                                  differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                                  thathelliprdquo

                                                                                                                                                                                                                                                  Match the Picture

                                                                                                                                                                                                                                                  Distraction Delay Training

                                                                                                                                                                                                                                                  Executive Estimates Training

                                                                                                                                                                                                                                                  X

                                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                  Asking two questionshellip

                                                                                                                                                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                                                                  this

                                                                                                                                                                                                                                                  what

                                                                                                                                                                                                                                                  I se

                                                                                                                                                                                                                                                  t out

                                                                                                                                                                                                                                                  to

                                                                                                                                                                                                                                                  do

                                                                                                                                                                                                                                                  bullYesbullYes

                                                                                                                                                                                                                                                  bullNobullYes

                                                                                                                                                                                                                                                  bullYesbullNo

                                                                                                                                                                                                                                                  bullNobullNo

                                                                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                                                                  this

                                                                                                                                                                                                                                                  what

                                                                                                                                                                                                                                                  I se

                                                                                                                                                                                                                                                  t out

                                                                                                                                                                                                                                                  to

                                                                                                                                                                                                                                                  do

                                                                                                                                                                                                                                                  bullFunbullOn-task

                                                                                                                                                                                                                                                  bullNot funbullOn-task

                                                                                                                                                                                                                                                  bullFunbullNot on-task

                                                                                                                                                                                                                                                  bullNot funbullNot on-task

                                                                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                  Volkow et al 2004

                                                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                                                  Quarterly QI review

                                                                                                                                                                                                                                                  The post-mortem

                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                  Yoga read

                                                                                                                                                                                                                                                  Staff meeting

                                                                                                                                                                                                                                                  Planningsession

                                                                                                                                                                                                                                                  Phone calls

                                                                                                                                                                                                                                                  billing

                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                  Learn French

                                                                                                                                                                                                                                                  Stop smoking

                                                                                                                                                                                                                                                  Be a better spouse

                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                                                                                                  DavidNowell

                                                                                                                                                                                                                                                  • Slide 1
                                                                                                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                                                                                                  • Slide 3
                                                                                                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                  • Slide 7
                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                  • Overview
                                                                                                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                  • Slide 17
                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                  • Slide 19
                                                                                                                                                                                                                                                  • Strategies
                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                                                                  • Slide 23
                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                  • Slide 25
                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                  • Slide 27
                                                                                                                                                                                                                                                  • Slide 28
                                                                                                                                                                                                                                                  • Slide 29
                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                  • Slide 35
                                                                                                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                                                                                                  • (C)APD
                                                                                                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                                                                                                  • Self-assessment
                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                  • Slide 42
                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                  • Core symptoms
                                                                                                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                  • Slide 53
                                                                                                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                                                                                                  • Slide 63
                                                                                                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                                                                                                  • Slide 66
                                                                                                                                                                                                                                                  • Slide 67
                                                                                                                                                                                                                                                  • ADHD and women
                                                                                                                                                                                                                                                  • Slide 69
                                                                                                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                                                                                                  • Slide 74
                                                                                                                                                                                                                                                  • Slide 75
                                                                                                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                  • Slide 84
                                                                                                                                                                                                                                                  • Slide 85
                                                                                                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                                                                                                  • Slide 89
                                                                                                                                                                                                                                                  • Slide 90
                                                                                                                                                                                                                                                  • Slide 91
                                                                                                                                                                                                                                                  • Slide 92
                                                                                                                                                                                                                                                  • Slide 93
                                                                                                                                                                                                                                                  • Slide 94
                                                                                                                                                                                                                                                  • Slide 95
                                                                                                                                                                                                                                                  • Slide 96
                                                                                                                                                                                                                                                  • Slide 97
                                                                                                                                                                                                                                                  • Slide 98
                                                                                                                                                                                                                                                  • Slide 99
                                                                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                                                                  • Slide 101
                                                                                                                                                                                                                                                  • Slide 102
                                                                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                                                                  • Slide 106
                                                                                                                                                                                                                                                  • Slide 107
                                                                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                                                                  • Slide 109
                                                                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                                                                  • Time Out
                                                                                                                                                                                                                                                  • Token economy
                                                                                                                                                                                                                                                  • Slide 113
                                                                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                                                                  • Slide 115
                                                                                                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                                                                                                  • Slide 117
                                                                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                                                                  • Metacognition
                                                                                                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                  • Slide 124
                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                  • Slide 128
                                                                                                                                                                                                                                                  • Slide 129
                                                                                                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                  • Slide 141
                                                                                                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                  • Slide 146
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                  • Slide 149
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                  • Slide 152
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                  • Slide 154
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                  • Slide 157
                                                                                                                                                                                                                                                  • Slide 158
                                                                                                                                                                                                                                                  • Slide 159
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                  • Slide 162
                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                  • Slide 164
                                                                                                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                  • Slide 166
                                                                                                                                                                                                                                                  • Slide 167
                                                                                                                                                                                                                                                  • Slide 168
                                                                                                                                                                                                                                                  • Slide 169
                                                                                                                                                                                                                                                  • Slide 170
                                                                                                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                  • Match the Picture
                                                                                                                                                                                                                                                  • Slide 176
                                                                                                                                                                                                                                                  • Slide 177
                                                                                                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                                                                                                  • Slide 179
                                                                                                                                                                                                                                                  • Slide 180
                                                                                                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                                                                                                  • Learning Time
                                                                                                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                                                                                                  • Slide 185
                                                                                                                                                                                                                                                  • Slide 186
                                                                                                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                                                                                                  • Slide 189
                                                                                                                                                                                                                                                  • Slide 190
                                                                                                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                  • Slide 194
                                                                                                                                                                                                                                                  • Slide 195
                                                                                                                                                                                                                                                  • Slide 196
                                                                                                                                                                                                                                                  • Slide 197
                                                                                                                                                                                                                                                  • Slide 198
                                                                                                                                                                                                                                                  • Slide 199
                                                                                                                                                                                                                                                  • Slide 200
                                                                                                                                                                                                                                                  • Slide 201
                                                                                                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                                                                                                  • The post-mortem
                                                                                                                                                                                                                                                  • Slide 204
                                                                                                                                                                                                                                                  • Slide 205
                                                                                                                                                                                                                                                  • Slide 206
                                                                                                                                                                                                                                                  • Slide 207
                                                                                                                                                                                                                                                  • Slide 208
                                                                                                                                                                                                                                                  • Slide 209
                                                                                                                                                                                                                                                  • Slide 210
                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                  • Slide 212
                                                                                                                                                                                                                                                  • Slide 213
                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                  • Slide 215
                                                                                                                                                                                                                                                  • Slide 216
                                                                                                                                                                                                                                                  • Slide 217
                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                  • A challengehellip
                                                                                                                                                                                                                                                  • Slide 222

                                                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                                                    bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                                    bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                                    bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                                    takerdquordquo

                                                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                                                    bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                                    bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                                    bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                                    bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                                    Self-Talk Proficiency

                                                                                                                                                                                                                                                    bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                                    bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                                    differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                                    thathelliprdquo

                                                                                                                                                                                                                                                    Match the Picture

                                                                                                                                                                                                                                                    Distraction Delay Training

                                                                                                                                                                                                                                                    Executive Estimates Training

                                                                                                                                                                                                                                                    X

                                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                                    What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                    Asking two questionshellip

                                                                                                                                                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                                                                    this

                                                                                                                                                                                                                                                    what

                                                                                                                                                                                                                                                    I se

                                                                                                                                                                                                                                                    t out

                                                                                                                                                                                                                                                    to

                                                                                                                                                                                                                                                    do

                                                                                                                                                                                                                                                    bullYesbullYes

                                                                                                                                                                                                                                                    bullNobullYes

                                                                                                                                                                                                                                                    bullYesbullNo

                                                                                                                                                                                                                                                    bullNobullNo

                                                                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                                                                    this

                                                                                                                                                                                                                                                    what

                                                                                                                                                                                                                                                    I se

                                                                                                                                                                                                                                                    t out

                                                                                                                                                                                                                                                    to

                                                                                                                                                                                                                                                    do

                                                                                                                                                                                                                                                    bullFunbullOn-task

                                                                                                                                                                                                                                                    bullNot funbullOn-task

                                                                                                                                                                                                                                                    bullFunbullNot on-task

                                                                                                                                                                                                                                                    bullNot funbullNot on-task

                                                                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                    Volkow et al 2004

                                                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                                                    Quarterly QI review

                                                                                                                                                                                                                                                    The post-mortem

                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                    Yoga read

                                                                                                                                                                                                                                                    Staff meeting

                                                                                                                                                                                                                                                    Planningsession

                                                                                                                                                                                                                                                    Phone calls

                                                                                                                                                                                                                                                    billing

                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                    Learn French

                                                                                                                                                                                                                                                    Stop smoking

                                                                                                                                                                                                                                                    Be a better spouse

                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                                                                                                    DavidNowell

                                                                                                                                                                                                                                                    • Slide 1
                                                                                                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                                                                                                    • Slide 3
                                                                                                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                    • Slide 7
                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                    • Overview
                                                                                                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                    • Slide 17
                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                    • Slide 19
                                                                                                                                                                                                                                                    • Strategies
                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                                                                    • Slide 23
                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                    • Slide 25
                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                    • Slide 27
                                                                                                                                                                                                                                                    • Slide 28
                                                                                                                                                                                                                                                    • Slide 29
                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                    • Slide 35
                                                                                                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                                                                                                    • (C)APD
                                                                                                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                                                                                                    • Self-assessment
                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                    • Slide 42
                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                    • Core symptoms
                                                                                                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                    • Slide 53
                                                                                                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                                                                                                    • Slide 63
                                                                                                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                                                                                                    • Slide 66
                                                                                                                                                                                                                                                    • Slide 67
                                                                                                                                                                                                                                                    • ADHD and women
                                                                                                                                                                                                                                                    • Slide 69
                                                                                                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                                                                                                    • Slide 74
                                                                                                                                                                                                                                                    • Slide 75
                                                                                                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                    • Slide 84
                                                                                                                                                                                                                                                    • Slide 85
                                                                                                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                                                                                                    • Slide 89
                                                                                                                                                                                                                                                    • Slide 90
                                                                                                                                                                                                                                                    • Slide 91
                                                                                                                                                                                                                                                    • Slide 92
                                                                                                                                                                                                                                                    • Slide 93
                                                                                                                                                                                                                                                    • Slide 94
                                                                                                                                                                                                                                                    • Slide 95
                                                                                                                                                                                                                                                    • Slide 96
                                                                                                                                                                                                                                                    • Slide 97
                                                                                                                                                                                                                                                    • Slide 98
                                                                                                                                                                                                                                                    • Slide 99
                                                                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                                                                    • Slide 101
                                                                                                                                                                                                                                                    • Slide 102
                                                                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                                                                    • Slide 106
                                                                                                                                                                                                                                                    • Slide 107
                                                                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                                                                    • Slide 109
                                                                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                                                                    • Time Out
                                                                                                                                                                                                                                                    • Token economy
                                                                                                                                                                                                                                                    • Slide 113
                                                                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                                                                    • Slide 115
                                                                                                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                                                                                                    • Slide 117
                                                                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                                                                    • Metacognition
                                                                                                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                    • Slide 124
                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                    • Slide 128
                                                                                                                                                                                                                                                    • Slide 129
                                                                                                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                    • Slide 141
                                                                                                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                    • Slide 146
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                    • Slide 149
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                    • Slide 152
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                    • Slide 154
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                    • Slide 157
                                                                                                                                                                                                                                                    • Slide 158
                                                                                                                                                                                                                                                    • Slide 159
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                    • Slide 162
                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                    • Slide 164
                                                                                                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                    • Slide 166
                                                                                                                                                                                                                                                    • Slide 167
                                                                                                                                                                                                                                                    • Slide 168
                                                                                                                                                                                                                                                    • Slide 169
                                                                                                                                                                                                                                                    • Slide 170
                                                                                                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                    • Match the Picture
                                                                                                                                                                                                                                                    • Slide 176
                                                                                                                                                                                                                                                    • Slide 177
                                                                                                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                                                                                                    • Slide 179
                                                                                                                                                                                                                                                    • Slide 180
                                                                                                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                                                                                                    • Learning Time
                                                                                                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                                                                                                    • Slide 185
                                                                                                                                                                                                                                                    • Slide 186
                                                                                                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                                                                                                    • Slide 189
                                                                                                                                                                                                                                                    • Slide 190
                                                                                                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                    • Slide 194
                                                                                                                                                                                                                                                    • Slide 195
                                                                                                                                                                                                                                                    • Slide 196
                                                                                                                                                                                                                                                    • Slide 197
                                                                                                                                                                                                                                                    • Slide 198
                                                                                                                                                                                                                                                    • Slide 199
                                                                                                                                                                                                                                                    • Slide 200
                                                                                                                                                                                                                                                    • Slide 201
                                                                                                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                                                                                                    • The post-mortem
                                                                                                                                                                                                                                                    • Slide 204
                                                                                                                                                                                                                                                    • Slide 205
                                                                                                                                                                                                                                                    • Slide 206
                                                                                                                                                                                                                                                    • Slide 207
                                                                                                                                                                                                                                                    • Slide 208
                                                                                                                                                                                                                                                    • Slide 209
                                                                                                                                                                                                                                                    • Slide 210
                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                    • Slide 212
                                                                                                                                                                                                                                                    • Slide 213
                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                    • Slide 215
                                                                                                                                                                                                                                                    • Slide 216
                                                                                                                                                                                                                                                    • Slide 217
                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                    • A challengehellip
                                                                                                                                                                                                                                                    • Slide 222

                                                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                                                      bull -ldquoHow are you going to know when to be readyrdquo

                                                                                                                                                                                                                                                      bull -ldquoHow are you going to stop yourself fromhelliprdquo

                                                                                                                                                                                                                                                      bull -ldquoWhat is your goalrdquo bull -ldquoWhat do you want it to look likerdquo bull -ldquoHow long do you think it will

                                                                                                                                                                                                                                                      takerdquordquo

                                                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                                                      bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                                      bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                                      bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                                      bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                                      Self-Talk Proficiency

                                                                                                                                                                                                                                                      bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                                      bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                                      differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                                      thathelliprdquo

                                                                                                                                                                                                                                                      Match the Picture

                                                                                                                                                                                                                                                      Distraction Delay Training

                                                                                                                                                                                                                                                      Executive Estimates Training

                                                                                                                                                                                                                                                      X

                                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                                      What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                      Asking two questionshellip

                                                                                                                                                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                                                                      this

                                                                                                                                                                                                                                                      what

                                                                                                                                                                                                                                                      I se

                                                                                                                                                                                                                                                      t out

                                                                                                                                                                                                                                                      to

                                                                                                                                                                                                                                                      do

                                                                                                                                                                                                                                                      bullYesbullYes

                                                                                                                                                                                                                                                      bullNobullYes

                                                                                                                                                                                                                                                      bullYesbullNo

                                                                                                                                                                                                                                                      bullNobullNo

                                                                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                                                                      this

                                                                                                                                                                                                                                                      what

                                                                                                                                                                                                                                                      I se

                                                                                                                                                                                                                                                      t out

                                                                                                                                                                                                                                                      to

                                                                                                                                                                                                                                                      do

                                                                                                                                                                                                                                                      bullFunbullOn-task

                                                                                                                                                                                                                                                      bullNot funbullOn-task

                                                                                                                                                                                                                                                      bullFunbullNot on-task

                                                                                                                                                                                                                                                      bullNot funbullNot on-task

                                                                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                      Volkow et al 2004

                                                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                                                      Quarterly QI review

                                                                                                                                                                                                                                                      The post-mortem

                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                      Yoga read

                                                                                                                                                                                                                                                      Staff meeting

                                                                                                                                                                                                                                                      Planningsession

                                                                                                                                                                                                                                                      Phone calls

                                                                                                                                                                                                                                                      billing

                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                      Learn French

                                                                                                                                                                                                                                                      Stop smoking

                                                                                                                                                                                                                                                      Be a better spouse

                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                                                                                                                      DavidNowell

                                                                                                                                                                                                                                                      • Slide 1
                                                                                                                                                                                                                                                      • hellipa challenge
                                                                                                                                                                                                                                                      • Slide 3
                                                                                                                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                      • Slide 7
                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                      • Overview
                                                                                                                                                                                                                                                      • This Dense Pudding
                                                                                                                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                                                                                      • Developmental considerations
                                                                                                                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                      • Slide 17
                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                      • Slide 19
                                                                                                                                                                                                                                                      • Strategies
                                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                                                                                      • Slide 23
                                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                      • Slide 25
                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                      • Slide 27
                                                                                                                                                                                                                                                      • Slide 28
                                                                                                                                                                                                                                                      • Slide 29
                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                      • Slide 35
                                                                                                                                                                                                                                                      • Strategies (2)
                                                                                                                                                                                                                                                      • (C)APD
                                                                                                                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                                                                                                                      • Self-assessment
                                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                      • Slide 42
                                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                      • Core symptoms
                                                                                                                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                      • Slide 53
                                                                                                                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                                                                                                                      • Slide 63
                                                                                                                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                      • ADHD and girls
                                                                                                                                                                                                                                                      • Slide 66
                                                                                                                                                                                                                                                      • Slide 67
                                                                                                                                                                                                                                                      • ADHD and women
                                                                                                                                                                                                                                                      • Slide 69
                                                                                                                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                      • The Executive Functions
                                                                                                                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                                                                                                                      • Slide 74
                                                                                                                                                                                                                                                      • Slide 75
                                                                                                                                                                                                                                                      • Appropriate expectations
                                                                                                                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                      • Slide 84
                                                                                                                                                                                                                                                      • Slide 85
                                                                                                                                                                                                                                                      • Strategies (3)
                                                                                                                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                                                                                                                      • Behavioral Supports
                                                                                                                                                                                                                                                      • Slide 89
                                                                                                                                                                                                                                                      • Slide 90
                                                                                                                                                                                                                                                      • Slide 91
                                                                                                                                                                                                                                                      • Slide 92
                                                                                                                                                                                                                                                      • Slide 93
                                                                                                                                                                                                                                                      • Slide 94
                                                                                                                                                                                                                                                      • Slide 95
                                                                                                                                                                                                                                                      • Slide 96
                                                                                                                                                                                                                                                      • Slide 97
                                                                                                                                                                                                                                                      • Slide 98
                                                                                                                                                                                                                                                      • Slide 99
                                                                                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                                                                                      • Slide 101
                                                                                                                                                                                                                                                      • Slide 102
                                                                                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                                                                                      • Slide 106
                                                                                                                                                                                                                                                      • Slide 107
                                                                                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                                                                                      • Slide 109
                                                                                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                                                                                      • Time Out
                                                                                                                                                                                                                                                      • Token economy
                                                                                                                                                                                                                                                      • Slide 113
                                                                                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                                                                                      • Slide 115
                                                                                                                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                                                                                                                      • Slide 117
                                                                                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                                                                                      • Metacognition
                                                                                                                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                      • Slide 124
                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                      • Slide 128
                                                                                                                                                                                                                                                      • Slide 129
                                                                                                                                                                                                                                                      • Broaden and Build
                                                                                                                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                      • Slide 141
                                                                                                                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                      • Slide 146
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                      • Slide 149
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                      • Slide 152
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                      • Slide 154
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                      • Slide 157
                                                                                                                                                                                                                                                      • Slide 158
                                                                                                                                                                                                                                                      • Slide 159
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                      • Slide 162
                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                      • Slide 164
                                                                                                                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                      • Slide 166
                                                                                                                                                                                                                                                      • Slide 167
                                                                                                                                                                                                                                                      • Slide 168
                                                                                                                                                                                                                                                      • Slide 169
                                                                                                                                                                                                                                                      • Slide 170
                                                                                                                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                      • Match the Picture
                                                                                                                                                                                                                                                      • Slide 176
                                                                                                                                                                                                                                                      • Slide 177
                                                                                                                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                                                                                                                      • Slide 179
                                                                                                                                                                                                                                                      • Slide 180
                                                                                                                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                                                                                                                      • Learning Time
                                                                                                                                                                                                                                                      • Learning Time (2)
                                                                                                                                                                                                                                                      • Learning Time (3)
                                                                                                                                                                                                                                                      • Slide 185
                                                                                                                                                                                                                                                      • Slide 186
                                                                                                                                                                                                                                                      • Learning Time (4)
                                                                                                                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                                                                                                                      • Slide 189
                                                                                                                                                                                                                                                      • Slide 190
                                                                                                                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                      • Slide 194
                                                                                                                                                                                                                                                      • Slide 195
                                                                                                                                                                                                                                                      • Slide 196
                                                                                                                                                                                                                                                      • Slide 197
                                                                                                                                                                                                                                                      • Slide 198
                                                                                                                                                                                                                                                      • Slide 199
                                                                                                                                                                                                                                                      • Slide 200
                                                                                                                                                                                                                                                      • Slide 201
                                                                                                                                                                                                                                                      • Quarterly QI review
                                                                                                                                                                                                                                                      • The post-mortem
                                                                                                                                                                                                                                                      • Slide 204
                                                                                                                                                                                                                                                      • Slide 205
                                                                                                                                                                                                                                                      • Slide 206
                                                                                                                                                                                                                                                      • Slide 207
                                                                                                                                                                                                                                                      • Slide 208
                                                                                                                                                                                                                                                      • Slide 209
                                                                                                                                                                                                                                                      • Slide 210
                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                      • Slide 212
                                                                                                                                                                                                                                                      • Slide 213
                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                      • Slide 215
                                                                                                                                                                                                                                                      • Slide 216
                                                                                                                                                                                                                                                      • Slide 217
                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                      • A challengehellip
                                                                                                                                                                                                                                                      • Slide 222

                                                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                                                        bull -ldquoHow are you going to know what you needrdquo

                                                                                                                                                                                                                                                        bull -ldquoHow are you going to know what is most importantrdquo

                                                                                                                                                                                                                                                        bull -ldquoHow are you going to decide what to do firstrdquo

                                                                                                                                                                                                                                                        bull -ldquoHow will you know when you are donerdquo

                                                                                                                                                                                                                                                        Self-Talk Proficiency

                                                                                                                                                                                                                                                        bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                                        bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                                        differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                                        thathelliprdquo

                                                                                                                                                                                                                                                        Match the Picture

                                                                                                                                                                                                                                                        Distraction Delay Training

                                                                                                                                                                                                                                                        Executive Estimates Training

                                                                                                                                                                                                                                                        X

                                                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                                                        What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                        Asking two questionshellip

                                                                                                                                                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                                                                        this

                                                                                                                                                                                                                                                        what

                                                                                                                                                                                                                                                        I se

                                                                                                                                                                                                                                                        t out

                                                                                                                                                                                                                                                        to

                                                                                                                                                                                                                                                        do

                                                                                                                                                                                                                                                        bullYesbullYes

                                                                                                                                                                                                                                                        bullNobullYes

                                                                                                                                                                                                                                                        bullYesbullNo

                                                                                                                                                                                                                                                        bullNobullNo

                                                                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                                                                        this

                                                                                                                                                                                                                                                        what

                                                                                                                                                                                                                                                        I se

                                                                                                                                                                                                                                                        t out

                                                                                                                                                                                                                                                        to

                                                                                                                                                                                                                                                        do

                                                                                                                                                                                                                                                        bullFunbullOn-task

                                                                                                                                                                                                                                                        bullNot funbullOn-task

                                                                                                                                                                                                                                                        bullFunbullNot on-task

                                                                                                                                                                                                                                                        bullNot funbullNot on-task

                                                                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                        Volkow et al 2004

                                                                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                                                                        Quarterly QI review

                                                                                                                                                                                                                                                        The post-mortem

                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                        Yoga read

                                                                                                                                                                                                                                                        Staff meeting

                                                                                                                                                                                                                                                        Planningsession

                                                                                                                                                                                                                                                        Phone calls

                                                                                                                                                                                                                                                        billing

                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                        Learn French

                                                                                                                                                                                                                                                        Stop smoking

                                                                                                                                                                                                                                                        Be a better spouse

                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                                                                                                                        DavidNowell

                                                                                                                                                                                                                                                        • Slide 1
                                                                                                                                                                                                                                                        • hellipa challenge
                                                                                                                                                                                                                                                        • Slide 3
                                                                                                                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                        • Slide 7
                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                        • Overview
                                                                                                                                                                                                                                                        • This Dense Pudding
                                                                                                                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                                                                                        • Developmental considerations
                                                                                                                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                        • Slide 17
                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                        • Slide 19
                                                                                                                                                                                                                                                        • Strategies
                                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                                                                                        • Slide 23
                                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                        • Slide 25
                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                        • Slide 27
                                                                                                                                                                                                                                                        • Slide 28
                                                                                                                                                                                                                                                        • Slide 29
                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                        • Slide 35
                                                                                                                                                                                                                                                        • Strategies (2)
                                                                                                                                                                                                                                                        • (C)APD
                                                                                                                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                                                                                                                        • Self-assessment
                                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                        • Slide 42
                                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                        • Core symptoms
                                                                                                                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                        • Slide 53
                                                                                                                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                                                                                                                        • Slide 63
                                                                                                                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                        • ADHD and girls
                                                                                                                                                                                                                                                        • Slide 66
                                                                                                                                                                                                                                                        • Slide 67
                                                                                                                                                                                                                                                        • ADHD and women
                                                                                                                                                                                                                                                        • Slide 69
                                                                                                                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                        • The Executive Functions
                                                                                                                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                                                                                                                        • Slide 74
                                                                                                                                                                                                                                                        • Slide 75
                                                                                                                                                                                                                                                        • Appropriate expectations
                                                                                                                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                        • Slide 84
                                                                                                                                                                                                                                                        • Slide 85
                                                                                                                                                                                                                                                        • Strategies (3)
                                                                                                                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                                                                                                                        • Behavioral Supports
                                                                                                                                                                                                                                                        • Slide 89
                                                                                                                                                                                                                                                        • Slide 90
                                                                                                                                                                                                                                                        • Slide 91
                                                                                                                                                                                                                                                        • Slide 92
                                                                                                                                                                                                                                                        • Slide 93
                                                                                                                                                                                                                                                        • Slide 94
                                                                                                                                                                                                                                                        • Slide 95
                                                                                                                                                                                                                                                        • Slide 96
                                                                                                                                                                                                                                                        • Slide 97
                                                                                                                                                                                                                                                        • Slide 98
                                                                                                                                                                                                                                                        • Slide 99
                                                                                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                                                                                        • Slide 101
                                                                                                                                                                                                                                                        • Slide 102
                                                                                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                                                                                        • Slide 106
                                                                                                                                                                                                                                                        • Slide 107
                                                                                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                                                                                        • Slide 109
                                                                                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                                                                                        • Time Out
                                                                                                                                                                                                                                                        • Token economy
                                                                                                                                                                                                                                                        • Slide 113
                                                                                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                                                                                        • Slide 115
                                                                                                                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                                                                                                                        • Slide 117
                                                                                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                                                                                        • Metacognition
                                                                                                                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                        • Slide 124
                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                        • Slide 128
                                                                                                                                                                                                                                                        • Slide 129
                                                                                                                                                                                                                                                        • Broaden and Build
                                                                                                                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                        • Slide 141
                                                                                                                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                        • Slide 146
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                        • Slide 149
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                        • Slide 152
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                        • Slide 154
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                        • Slide 157
                                                                                                                                                                                                                                                        • Slide 158
                                                                                                                                                                                                                                                        • Slide 159
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                        • Slide 162
                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                        • Slide 164
                                                                                                                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                        • Slide 166
                                                                                                                                                                                                                                                        • Slide 167
                                                                                                                                                                                                                                                        • Slide 168
                                                                                                                                                                                                                                                        • Slide 169
                                                                                                                                                                                                                                                        • Slide 170
                                                                                                                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                        • Match the Picture
                                                                                                                                                                                                                                                        • Slide 176
                                                                                                                                                                                                                                                        • Slide 177
                                                                                                                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                                                                                                                        • Slide 179
                                                                                                                                                                                                                                                        • Slide 180
                                                                                                                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                                                                                                                        • Learning Time
                                                                                                                                                                                                                                                        • Learning Time (2)
                                                                                                                                                                                                                                                        • Learning Time (3)
                                                                                                                                                                                                                                                        • Slide 185
                                                                                                                                                                                                                                                        • Slide 186
                                                                                                                                                                                                                                                        • Learning Time (4)
                                                                                                                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                                                                                                                        • Slide 189
                                                                                                                                                                                                                                                        • Slide 190
                                                                                                                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                        • Slide 194
                                                                                                                                                                                                                                                        • Slide 195
                                                                                                                                                                                                                                                        • Slide 196
                                                                                                                                                                                                                                                        • Slide 197
                                                                                                                                                                                                                                                        • Slide 198
                                                                                                                                                                                                                                                        • Slide 199
                                                                                                                                                                                                                                                        • Slide 200
                                                                                                                                                                                                                                                        • Slide 201
                                                                                                                                                                                                                                                        • Quarterly QI review
                                                                                                                                                                                                                                                        • The post-mortem
                                                                                                                                                                                                                                                        • Slide 204
                                                                                                                                                                                                                                                        • Slide 205
                                                                                                                                                                                                                                                        • Slide 206
                                                                                                                                                                                                                                                        • Slide 207
                                                                                                                                                                                                                                                        • Slide 208
                                                                                                                                                                                                                                                        • Slide 209
                                                                                                                                                                                                                                                        • Slide 210
                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                        • Slide 212
                                                                                                                                                                                                                                                        • Slide 213
                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                        • Slide 215
                                                                                                                                                                                                                                                        • Slide 216
                                                                                                                                                                                                                                                        • Slide 217
                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                        • A challengehellip
                                                                                                                                                                                                                                                        • Slide 222

                                                                                                                                                                                                                                                          Self-Talk Proficiency

                                                                                                                                                                                                                                                          bull -ldquoHow will you continue when you are tiredrdquo

                                                                                                                                                                                                                                                          bull -ldquoHow did that work outrdquo bull -ldquoHow long do you think that tookrdquo bull -ldquoWould you do anything

                                                                                                                                                                                                                                                          differentlyrdquo ldquoWho will be the first person to notice

                                                                                                                                                                                                                                                          thathelliprdquo

                                                                                                                                                                                                                                                          Match the Picture

                                                                                                                                                                                                                                                          Distraction Delay Training

                                                                                                                                                                                                                                                          Executive Estimates Training

                                                                                                                                                                                                                                                          X

                                                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                                                          What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                                                          Learning Time

                                                                                                                                                                                                                                                          Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                          Asking two questionshellip

                                                                                                                                                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                                                                          this

                                                                                                                                                                                                                                                          what

                                                                                                                                                                                                                                                          I se

                                                                                                                                                                                                                                                          t out

                                                                                                                                                                                                                                                          to

                                                                                                                                                                                                                                                          do

                                                                                                                                                                                                                                                          bullYesbullYes

                                                                                                                                                                                                                                                          bullNobullYes

                                                                                                                                                                                                                                                          bullYesbullNo

                                                                                                                                                                                                                                                          bullNobullNo

                                                                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                                                                          this

                                                                                                                                                                                                                                                          what

                                                                                                                                                                                                                                                          I se

                                                                                                                                                                                                                                                          t out

                                                                                                                                                                                                                                                          to

                                                                                                                                                                                                                                                          do

                                                                                                                                                                                                                                                          bullFunbullOn-task

                                                                                                                                                                                                                                                          bullNot funbullOn-task

                                                                                                                                                                                                                                                          bullFunbullNot on-task

                                                                                                                                                                                                                                                          bullNot funbullNot on-task

                                                                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                          Volkow et al 2004

                                                                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                                                                          Quarterly QI review

                                                                                                                                                                                                                                                          The post-mortem

                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                          Yoga read

                                                                                                                                                                                                                                                          Staff meeting

                                                                                                                                                                                                                                                          Planningsession

                                                                                                                                                                                                                                                          Phone calls

                                                                                                                                                                                                                                                          billing

                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                          Learn French

                                                                                                                                                                                                                                                          Stop smoking

                                                                                                                                                                                                                                                          Be a better spouse

                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                                                                                                                          DavidNowell

                                                                                                                                                                                                                                                          • Slide 1
                                                                                                                                                                                                                                                          • hellipa challenge
                                                                                                                                                                                                                                                          • Slide 3
                                                                                                                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                          • Slide 7
                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                          • Overview
                                                                                                                                                                                                                                                          • This Dense Pudding
                                                                                                                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                                                                                          • Developmental considerations
                                                                                                                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                          • Slide 17
                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                          • Slide 19
                                                                                                                                                                                                                                                          • Strategies
                                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                                                                                          • Slide 23
                                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                          • Slide 25
                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                          • Slide 27
                                                                                                                                                                                                                                                          • Slide 28
                                                                                                                                                                                                                                                          • Slide 29
                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                          • Slide 35
                                                                                                                                                                                                                                                          • Strategies (2)
                                                                                                                                                                                                                                                          • (C)APD
                                                                                                                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                                                                                                                          • Self-assessment
                                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                          • Slide 42
                                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                          • Core symptoms
                                                                                                                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                          • Slide 53
                                                                                                                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                                                                                                                          • Slide 63
                                                                                                                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                          • ADHD and girls
                                                                                                                                                                                                                                                          • Slide 66
                                                                                                                                                                                                                                                          • Slide 67
                                                                                                                                                                                                                                                          • ADHD and women
                                                                                                                                                                                                                                                          • Slide 69
                                                                                                                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                          • The Executive Functions
                                                                                                                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                                                                                                                          • Slide 74
                                                                                                                                                                                                                                                          • Slide 75
                                                                                                                                                                                                                                                          • Appropriate expectations
                                                                                                                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                          • Slide 84
                                                                                                                                                                                                                                                          • Slide 85
                                                                                                                                                                                                                                                          • Strategies (3)
                                                                                                                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                                                                                                                          • Behavioral Supports
                                                                                                                                                                                                                                                          • Slide 89
                                                                                                                                                                                                                                                          • Slide 90
                                                                                                                                                                                                                                                          • Slide 91
                                                                                                                                                                                                                                                          • Slide 92
                                                                                                                                                                                                                                                          • Slide 93
                                                                                                                                                                                                                                                          • Slide 94
                                                                                                                                                                                                                                                          • Slide 95
                                                                                                                                                                                                                                                          • Slide 96
                                                                                                                                                                                                                                                          • Slide 97
                                                                                                                                                                                                                                                          • Slide 98
                                                                                                                                                                                                                                                          • Slide 99
                                                                                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                                                                                          • Slide 101
                                                                                                                                                                                                                                                          • Slide 102
                                                                                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                                                                                          • Slide 106
                                                                                                                                                                                                                                                          • Slide 107
                                                                                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                                                                                          • Slide 109
                                                                                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                                                                                          • Time Out
                                                                                                                                                                                                                                                          • Token economy
                                                                                                                                                                                                                                                          • Slide 113
                                                                                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                                                                                          • Slide 115
                                                                                                                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                                                                                                                          • Slide 117
                                                                                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                                                                                          • Metacognition
                                                                                                                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                          • Slide 124
                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                          • Slide 128
                                                                                                                                                                                                                                                          • Slide 129
                                                                                                                                                                                                                                                          • Broaden and Build
                                                                                                                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                          • Slide 141
                                                                                                                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                          • Slide 146
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                          • Slide 149
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                          • Slide 152
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                          • Slide 154
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                          • Slide 157
                                                                                                                                                                                                                                                          • Slide 158
                                                                                                                                                                                                                                                          • Slide 159
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                          • Slide 162
                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                          • Slide 164
                                                                                                                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                          • Slide 166
                                                                                                                                                                                                                                                          • Slide 167
                                                                                                                                                                                                                                                          • Slide 168
                                                                                                                                                                                                                                                          • Slide 169
                                                                                                                                                                                                                                                          • Slide 170
                                                                                                                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                          • Match the Picture
                                                                                                                                                                                                                                                          • Slide 176
                                                                                                                                                                                                                                                          • Slide 177
                                                                                                                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                                                                                                                          • Slide 179
                                                                                                                                                                                                                                                          • Slide 180
                                                                                                                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                                                                                                                          • Learning Time
                                                                                                                                                                                                                                                          • Learning Time (2)
                                                                                                                                                                                                                                                          • Learning Time (3)
                                                                                                                                                                                                                                                          • Slide 185
                                                                                                                                                                                                                                                          • Slide 186
                                                                                                                                                                                                                                                          • Learning Time (4)
                                                                                                                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                                                                                                                          • Slide 189
                                                                                                                                                                                                                                                          • Slide 190
                                                                                                                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                          • Slide 194
                                                                                                                                                                                                                                                          • Slide 195
                                                                                                                                                                                                                                                          • Slide 196
                                                                                                                                                                                                                                                          • Slide 197
                                                                                                                                                                                                                                                          • Slide 198
                                                                                                                                                                                                                                                          • Slide 199
                                                                                                                                                                                                                                                          • Slide 200
                                                                                                                                                                                                                                                          • Slide 201
                                                                                                                                                                                                                                                          • Quarterly QI review
                                                                                                                                                                                                                                                          • The post-mortem
                                                                                                                                                                                                                                                          • Slide 204
                                                                                                                                                                                                                                                          • Slide 205
                                                                                                                                                                                                                                                          • Slide 206
                                                                                                                                                                                                                                                          • Slide 207
                                                                                                                                                                                                                                                          • Slide 208
                                                                                                                                                                                                                                                          • Slide 209
                                                                                                                                                                                                                                                          • Slide 210
                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                          • Slide 212
                                                                                                                                                                                                                                                          • Slide 213
                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                          • Slide 215
                                                                                                                                                                                                                                                          • Slide 216
                                                                                                                                                                                                                                                          • Slide 217
                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                          • A challengehellip
                                                                                                                                                                                                                                                          • Slide 222

                                                                                                                                                                                                                                                            Match the Picture

                                                                                                                                                                                                                                                            Distraction Delay Training

                                                                                                                                                                                                                                                            Executive Estimates Training

                                                                                                                                                                                                                                                            X

                                                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                                                            What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                                                            Learning Time

                                                                                                                                                                                                                                                            Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                            Asking two questionshellip

                                                                                                                                                                                                                                                            Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                                                                            this

                                                                                                                                                                                                                                                            what

                                                                                                                                                                                                                                                            I se

                                                                                                                                                                                                                                                            t out

                                                                                                                                                                                                                                                            to

                                                                                                                                                                                                                                                            do

                                                                                                                                                                                                                                                            bullYesbullYes

                                                                                                                                                                                                                                                            bullNobullYes

                                                                                                                                                                                                                                                            bullYesbullNo

                                                                                                                                                                                                                                                            bullNobullNo

                                                                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                                                                            this

                                                                                                                                                                                                                                                            what

                                                                                                                                                                                                                                                            I se

                                                                                                                                                                                                                                                            t out

                                                                                                                                                                                                                                                            to

                                                                                                                                                                                                                                                            do

                                                                                                                                                                                                                                                            bullFunbullOn-task

                                                                                                                                                                                                                                                            bullNot funbullOn-task

                                                                                                                                                                                                                                                            bullFunbullNot on-task

                                                                                                                                                                                                                                                            bullNot funbullNot on-task

                                                                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                            Volkow et al 2004

                                                                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                                                                            Quarterly QI review

                                                                                                                                                                                                                                                            The post-mortem

                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                            Yoga read

                                                                                                                                                                                                                                                            Staff meeting

                                                                                                                                                                                                                                                            Planningsession

                                                                                                                                                                                                                                                            Phone calls

                                                                                                                                                                                                                                                            billing

                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                            Learn French

                                                                                                                                                                                                                                                            Stop smoking

                                                                                                                                                                                                                                                            Be a better spouse

                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                                                                                                                            DavidNowell

                                                                                                                                                                                                                                                            • Slide 1
                                                                                                                                                                                                                                                            • hellipa challenge
                                                                                                                                                                                                                                                            • Slide 3
                                                                                                                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                            • Slide 7
                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                            • Overview
                                                                                                                                                                                                                                                            • This Dense Pudding
                                                                                                                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                                                                                            • Developmental considerations
                                                                                                                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                            • Slide 17
                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                            • Slide 19
                                                                                                                                                                                                                                                            • Strategies
                                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                                                                                            • Slide 23
                                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                            • Slide 25
                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                            • Slide 27
                                                                                                                                                                                                                                                            • Slide 28
                                                                                                                                                                                                                                                            • Slide 29
                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                            • Slide 35
                                                                                                                                                                                                                                                            • Strategies (2)
                                                                                                                                                                                                                                                            • (C)APD
                                                                                                                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                                                                                                                            • Self-assessment
                                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                            • Slide 42
                                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                            • Core symptoms
                                                                                                                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                            • Slide 53
                                                                                                                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                                                                                                                            • Slide 63
                                                                                                                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                            • ADHD and girls
                                                                                                                                                                                                                                                            • Slide 66
                                                                                                                                                                                                                                                            • Slide 67
                                                                                                                                                                                                                                                            • ADHD and women
                                                                                                                                                                                                                                                            • Slide 69
                                                                                                                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                            • The Executive Functions
                                                                                                                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                                                                                                                            • Slide 74
                                                                                                                                                                                                                                                            • Slide 75
                                                                                                                                                                                                                                                            • Appropriate expectations
                                                                                                                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                            • Slide 84
                                                                                                                                                                                                                                                            • Slide 85
                                                                                                                                                                                                                                                            • Strategies (3)
                                                                                                                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                                                                                                                            • Behavioral Supports
                                                                                                                                                                                                                                                            • Slide 89
                                                                                                                                                                                                                                                            • Slide 90
                                                                                                                                                                                                                                                            • Slide 91
                                                                                                                                                                                                                                                            • Slide 92
                                                                                                                                                                                                                                                            • Slide 93
                                                                                                                                                                                                                                                            • Slide 94
                                                                                                                                                                                                                                                            • Slide 95
                                                                                                                                                                                                                                                            • Slide 96
                                                                                                                                                                                                                                                            • Slide 97
                                                                                                                                                                                                                                                            • Slide 98
                                                                                                                                                                                                                                                            • Slide 99
                                                                                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                                                                                            • Slide 101
                                                                                                                                                                                                                                                            • Slide 102
                                                                                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                                                                                            • Slide 106
                                                                                                                                                                                                                                                            • Slide 107
                                                                                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                                                                                            • Slide 109
                                                                                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                                                                                            • Time Out
                                                                                                                                                                                                                                                            • Token economy
                                                                                                                                                                                                                                                            • Slide 113
                                                                                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                                                                                            • Slide 115
                                                                                                                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                                                                                                                            • Slide 117
                                                                                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                                                                                            • Metacognition
                                                                                                                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                            • Slide 124
                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                            • Slide 128
                                                                                                                                                                                                                                                            • Slide 129
                                                                                                                                                                                                                                                            • Broaden and Build
                                                                                                                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                            • Slide 141
                                                                                                                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                            • Slide 146
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                            • Slide 149
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                            • Slide 152
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                            • Slide 154
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                            • Slide 157
                                                                                                                                                                                                                                                            • Slide 158
                                                                                                                                                                                                                                                            • Slide 159
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                            • Slide 162
                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                            • Slide 164
                                                                                                                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                            • Slide 166
                                                                                                                                                                                                                                                            • Slide 167
                                                                                                                                                                                                                                                            • Slide 168
                                                                                                                                                                                                                                                            • Slide 169
                                                                                                                                                                                                                                                            • Slide 170
                                                                                                                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                            • Match the Picture
                                                                                                                                                                                                                                                            • Slide 176
                                                                                                                                                                                                                                                            • Slide 177
                                                                                                                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                                                                                                                            • Slide 179
                                                                                                                                                                                                                                                            • Slide 180
                                                                                                                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                                                                                                                            • Learning Time
                                                                                                                                                                                                                                                            • Learning Time (2)
                                                                                                                                                                                                                                                            • Learning Time (3)
                                                                                                                                                                                                                                                            • Slide 185
                                                                                                                                                                                                                                                            • Slide 186
                                                                                                                                                                                                                                                            • Learning Time (4)
                                                                                                                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                                                                                                                            • Slide 189
                                                                                                                                                                                                                                                            • Slide 190
                                                                                                                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                            • Slide 194
                                                                                                                                                                                                                                                            • Slide 195
                                                                                                                                                                                                                                                            • Slide 196
                                                                                                                                                                                                                                                            • Slide 197
                                                                                                                                                                                                                                                            • Slide 198
                                                                                                                                                                                                                                                            • Slide 199
                                                                                                                                                                                                                                                            • Slide 200
                                                                                                                                                                                                                                                            • Slide 201
                                                                                                                                                                                                                                                            • Quarterly QI review
                                                                                                                                                                                                                                                            • The post-mortem
                                                                                                                                                                                                                                                            • Slide 204
                                                                                                                                                                                                                                                            • Slide 205
                                                                                                                                                                                                                                                            • Slide 206
                                                                                                                                                                                                                                                            • Slide 207
                                                                                                                                                                                                                                                            • Slide 208
                                                                                                                                                                                                                                                            • Slide 209
                                                                                                                                                                                                                                                            • Slide 210
                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                            • Slide 212
                                                                                                                                                                                                                                                            • Slide 213
                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                            • Slide 215
                                                                                                                                                                                                                                                            • Slide 216
                                                                                                                                                                                                                                                            • Slide 217
                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                            • A challengehellip
                                                                                                                                                                                                                                                            • Slide 222

                                                                                                                                                                                                                                                              Distraction Delay Training

                                                                                                                                                                                                                                                              Executive Estimates Training

                                                                                                                                                                                                                                                              X

                                                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                                                              What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                                                              Learning Time

                                                                                                                                                                                                                                                              Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                              Asking two questionshellip

                                                                                                                                                                                                                                                              Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                                                                                              this

                                                                                                                                                                                                                                                              what

                                                                                                                                                                                                                                                              I se

                                                                                                                                                                                                                                                              t out

                                                                                                                                                                                                                                                              to

                                                                                                                                                                                                                                                              do

                                                                                                                                                                                                                                                              bullYesbullYes

                                                                                                                                                                                                                                                              bullNobullYes

                                                                                                                                                                                                                                                              bullYesbullNo

                                                                                                                                                                                                                                                              bullNobullNo

                                                                                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                                                                                              this

                                                                                                                                                                                                                                                              what

                                                                                                                                                                                                                                                              I se

                                                                                                                                                                                                                                                              t out

                                                                                                                                                                                                                                                              to

                                                                                                                                                                                                                                                              do

                                                                                                                                                                                                                                                              bullFunbullOn-task

                                                                                                                                                                                                                                                              bullNot funbullOn-task

                                                                                                                                                                                                                                                              bullFunbullNot on-task

                                                                                                                                                                                                                                                              bullNot funbullNot on-task

                                                                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                              Volkow et al 2004

                                                                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                                                                              Quarterly QI review

                                                                                                                                                                                                                                                              The post-mortem

                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                              Yoga read

                                                                                                                                                                                                                                                              Staff meeting

                                                                                                                                                                                                                                                              Planningsession

                                                                                                                                                                                                                                                              Phone calls

                                                                                                                                                                                                                                                              billing

                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                              Learn French

                                                                                                                                                                                                                                                              Stop smoking

                                                                                                                                                                                                                                                              Be a better spouse

                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                                                                                                                              DavidNowell

                                                                                                                                                                                                                                                              • Slide 1
                                                                                                                                                                                                                                                              • hellipa challenge
                                                                                                                                                                                                                                                              • Slide 3
                                                                                                                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                              • Slide 7
                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                              • Overview
                                                                                                                                                                                                                                                              • This Dense Pudding
                                                                                                                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                                                                                              • Developmental considerations
                                                                                                                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                              • Slide 17
                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                              • Slide 19
                                                                                                                                                                                                                                                              • Strategies
                                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                                                                                              • Slide 23
                                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                              • Slide 25
                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                              • Slide 27
                                                                                                                                                                                                                                                              • Slide 28
                                                                                                                                                                                                                                                              • Slide 29
                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                              • Slide 35
                                                                                                                                                                                                                                                              • Strategies (2)
                                                                                                                                                                                                                                                              • (C)APD
                                                                                                                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                                                                                                                              • Self-assessment
                                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                              • Slide 42
                                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                              • Core symptoms
                                                                                                                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                              • Slide 53
                                                                                                                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                                                                                                                              • Slide 63
                                                                                                                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                              • ADHD and girls
                                                                                                                                                                                                                                                              • Slide 66
                                                                                                                                                                                                                                                              • Slide 67
                                                                                                                                                                                                                                                              • ADHD and women
                                                                                                                                                                                                                                                              • Slide 69
                                                                                                                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                              • The Executive Functions
                                                                                                                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                                                                                                                              • Slide 74
                                                                                                                                                                                                                                                              • Slide 75
                                                                                                                                                                                                                                                              • Appropriate expectations
                                                                                                                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                              • Slide 84
                                                                                                                                                                                                                                                              • Slide 85
                                                                                                                                                                                                                                                              • Strategies (3)
                                                                                                                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                                                                                                                              • Behavioral Supports
                                                                                                                                                                                                                                                              • Slide 89
                                                                                                                                                                                                                                                              • Slide 90
                                                                                                                                                                                                                                                              • Slide 91
                                                                                                                                                                                                                                                              • Slide 92
                                                                                                                                                                                                                                                              • Slide 93
                                                                                                                                                                                                                                                              • Slide 94
                                                                                                                                                                                                                                                              • Slide 95
                                                                                                                                                                                                                                                              • Slide 96
                                                                                                                                                                                                                                                              • Slide 97
                                                                                                                                                                                                                                                              • Slide 98
                                                                                                                                                                                                                                                              • Slide 99
                                                                                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                                                                                              • Slide 101
                                                                                                                                                                                                                                                              • Slide 102
                                                                                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                                                                                              • Slide 106
                                                                                                                                                                                                                                                              • Slide 107
                                                                                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                                                                                              • Slide 109
                                                                                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                                                                                              • Time Out
                                                                                                                                                                                                                                                              • Token economy
                                                                                                                                                                                                                                                              • Slide 113
                                                                                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                                                                                              • Slide 115
                                                                                                                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                                                                                                                              • Slide 117
                                                                                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                                                                                              • Metacognition
                                                                                                                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                              • Slide 124
                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                              • Slide 128
                                                                                                                                                                                                                                                              • Slide 129
                                                                                                                                                                                                                                                              • Broaden and Build
                                                                                                                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                              • Slide 141
                                                                                                                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                              • Slide 146
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                              • Slide 149
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                              • Slide 152
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                              • Slide 154
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                              • Slide 157
                                                                                                                                                                                                                                                              • Slide 158
                                                                                                                                                                                                                                                              • Slide 159
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                              • Slide 162
                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                              • Slide 164
                                                                                                                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                              • Slide 166
                                                                                                                                                                                                                                                              • Slide 167
                                                                                                                                                                                                                                                              • Slide 168
                                                                                                                                                                                                                                                              • Slide 169
                                                                                                                                                                                                                                                              • Slide 170
                                                                                                                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                              • Match the Picture
                                                                                                                                                                                                                                                              • Slide 176
                                                                                                                                                                                                                                                              • Slide 177
                                                                                                                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                                                                                                                              • Slide 179
                                                                                                                                                                                                                                                              • Slide 180
                                                                                                                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                                                                                                                              • Learning Time
                                                                                                                                                                                                                                                              • Learning Time (2)
                                                                                                                                                                                                                                                              • Learning Time (3)
                                                                                                                                                                                                                                                              • Slide 185
                                                                                                                                                                                                                                                              • Slide 186
                                                                                                                                                                                                                                                              • Learning Time (4)
                                                                                                                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                                                                                                                              • Slide 189
                                                                                                                                                                                                                                                              • Slide 190
                                                                                                                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                              • Slide 194
                                                                                                                                                                                                                                                              • Slide 195
                                                                                                                                                                                                                                                              • Slide 196
                                                                                                                                                                                                                                                              • Slide 197
                                                                                                                                                                                                                                                              • Slide 198
                                                                                                                                                                                                                                                              • Slide 199
                                                                                                                                                                                                                                                              • Slide 200
                                                                                                                                                                                                                                                              • Slide 201
                                                                                                                                                                                                                                                              • Quarterly QI review
                                                                                                                                                                                                                                                              • The post-mortem
                                                                                                                                                                                                                                                              • Slide 204
                                                                                                                                                                                                                                                              • Slide 205
                                                                                                                                                                                                                                                              • Slide 206
                                                                                                                                                                                                                                                              • Slide 207
                                                                                                                                                                                                                                                              • Slide 208
                                                                                                                                                                                                                                                              • Slide 209
                                                                                                                                                                                                                                                              • Slide 210
                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                              • Slide 212
                                                                                                                                                                                                                                                              • Slide 213
                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                              • Slide 215
                                                                                                                                                                                                                                                              • Slide 216
                                                                                                                                                                                                                                                              • Slide 217
                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                              • A challengehellip
                                                                                                                                                                                                                                                              • Slide 222

                                                                                                                                                                                                                                                                Executive Estimates Training

                                                                                                                                                                                                                                                                X

                                                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                                                What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                                                Learning Time

                                                                                                                                                                                                                                                                Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                                Asking two questionshellip

                                                                                                                                                                                                                                                                Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                                                                                this

                                                                                                                                                                                                                                                                what

                                                                                                                                                                                                                                                                I se

                                                                                                                                                                                                                                                                t out

                                                                                                                                                                                                                                                                to

                                                                                                                                                                                                                                                                do

                                                                                                                                                                                                                                                                bullYesbullYes

                                                                                                                                                                                                                                                                bullNobullYes

                                                                                                                                                                                                                                                                bullYesbullNo

                                                                                                                                                                                                                                                                bullNobullNo

                                                                                                                                                                                                                                                                Am I having fun nowIs

                                                                                                                                                                                                                                                                this

                                                                                                                                                                                                                                                                what

                                                                                                                                                                                                                                                                I se

                                                                                                                                                                                                                                                                t out

                                                                                                                                                                                                                                                                to

                                                                                                                                                                                                                                                                do

                                                                                                                                                                                                                                                                bullFunbullOn-task

                                                                                                                                                                                                                                                                bullNot funbullOn-task

                                                                                                                                                                                                                                                                bullFunbullNot on-task

                                                                                                                                                                                                                                                                bullNot funbullNot on-task

                                                                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                Volkow et al 2004

                                                                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                                                                Quarterly QI review

                                                                                                                                                                                                                                                                The post-mortem

                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                Yoga read

                                                                                                                                                                                                                                                                Staff meeting

                                                                                                                                                                                                                                                                Planningsession

                                                                                                                                                                                                                                                                Phone calls

                                                                                                                                                                                                                                                                billing

                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                Learn French

                                                                                                                                                                                                                                                                Stop smoking

                                                                                                                                                                                                                                                                Be a better spouse

                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                                                                                                                DavidNowell

                                                                                                                                                                                                                                                                • Slide 1
                                                                                                                                                                                                                                                                • hellipa challenge
                                                                                                                                                                                                                                                                • Slide 3
                                                                                                                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                • Slide 7
                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                • Overview
                                                                                                                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                                                                                • Developmental considerations
                                                                                                                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                • Slide 17
                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                • Slide 19
                                                                                                                                                                                                                                                                • Strategies
                                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                                                                                • Slide 23
                                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                • Slide 25
                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                • Slide 27
                                                                                                                                                                                                                                                                • Slide 28
                                                                                                                                                                                                                                                                • Slide 29
                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                • Slide 35
                                                                                                                                                                                                                                                                • Strategies (2)
                                                                                                                                                                                                                                                                • (C)APD
                                                                                                                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                • Self-assessment
                                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                • Slide 42
                                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                • Core symptoms
                                                                                                                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                • Slide 53
                                                                                                                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                • Slide 63
                                                                                                                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                • ADHD and girls
                                                                                                                                                                                                                                                                • Slide 66
                                                                                                                                                                                                                                                                • Slide 67
                                                                                                                                                                                                                                                                • ADHD and women
                                                                                                                                                                                                                                                                • Slide 69
                                                                                                                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                • The Executive Functions
                                                                                                                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                                                                                                                • Slide 74
                                                                                                                                                                                                                                                                • Slide 75
                                                                                                                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                • Slide 84
                                                                                                                                                                                                                                                                • Slide 85
                                                                                                                                                                                                                                                                • Strategies (3)
                                                                                                                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                                                                                                                • Slide 89
                                                                                                                                                                                                                                                                • Slide 90
                                                                                                                                                                                                                                                                • Slide 91
                                                                                                                                                                                                                                                                • Slide 92
                                                                                                                                                                                                                                                                • Slide 93
                                                                                                                                                                                                                                                                • Slide 94
                                                                                                                                                                                                                                                                • Slide 95
                                                                                                                                                                                                                                                                • Slide 96
                                                                                                                                                                                                                                                                • Slide 97
                                                                                                                                                                                                                                                                • Slide 98
                                                                                                                                                                                                                                                                • Slide 99
                                                                                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                                                                                • Slide 101
                                                                                                                                                                                                                                                                • Slide 102
                                                                                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                                                                                • Slide 106
                                                                                                                                                                                                                                                                • Slide 107
                                                                                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                                                                                • Slide 109
                                                                                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                                                                                • Time Out
                                                                                                                                                                                                                                                                • Token economy
                                                                                                                                                                                                                                                                • Slide 113
                                                                                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                                                                                • Slide 115
                                                                                                                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                                                                                                                • Slide 117
                                                                                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                                                                                • Metacognition
                                                                                                                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                • Slide 124
                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                • Slide 128
                                                                                                                                                                                                                                                                • Slide 129
                                                                                                                                                                                                                                                                • Broaden and Build
                                                                                                                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                • Slide 141
                                                                                                                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                • Slide 146
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                • Slide 149
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                • Slide 152
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                • Slide 154
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                • Slide 157
                                                                                                                                                                                                                                                                • Slide 158
                                                                                                                                                                                                                                                                • Slide 159
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                • Slide 162
                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                • Slide 164
                                                                                                                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                • Slide 166
                                                                                                                                                                                                                                                                • Slide 167
                                                                                                                                                                                                                                                                • Slide 168
                                                                                                                                                                                                                                                                • Slide 169
                                                                                                                                                                                                                                                                • Slide 170
                                                                                                                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                • Match the Picture
                                                                                                                                                                                                                                                                • Slide 176
                                                                                                                                                                                                                                                                • Slide 177
                                                                                                                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                                                                                                                • Slide 179
                                                                                                                                                                                                                                                                • Slide 180
                                                                                                                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                                                                                                                • Learning Time
                                                                                                                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                                                                                                                • Slide 185
                                                                                                                                                                                                                                                                • Slide 186
                                                                                                                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                                                                                                                • Slide 189
                                                                                                                                                                                                                                                                • Slide 190
                                                                                                                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                • Slide 194
                                                                                                                                                                                                                                                                • Slide 195
                                                                                                                                                                                                                                                                • Slide 196
                                                                                                                                                                                                                                                                • Slide 197
                                                                                                                                                                                                                                                                • Slide 198
                                                                                                                                                                                                                                                                • Slide 199
                                                                                                                                                                                                                                                                • Slide 200
                                                                                                                                                                                                                                                                • Slide 201
                                                                                                                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                                                                                                                • The post-mortem
                                                                                                                                                                                                                                                                • Slide 204
                                                                                                                                                                                                                                                                • Slide 205
                                                                                                                                                                                                                                                                • Slide 206
                                                                                                                                                                                                                                                                • Slide 207
                                                                                                                                                                                                                                                                • Slide 208
                                                                                                                                                                                                                                                                • Slide 209
                                                                                                                                                                                                                                                                • Slide 210
                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                • Slide 212
                                                                                                                                                                                                                                                                • Slide 213
                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                • Slide 215
                                                                                                                                                                                                                                                                • Slide 216
                                                                                                                                                                                                                                                                • Slide 217
                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                • A challengehellip
                                                                                                                                                                                                                                                                • Slide 222

                                                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                                                  What is the ldquofeltrdquo experience of time What is the ldquofrontalrdquo aspect of time

                                                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                                                  Learning Time

                                                                                                                                                                                                                                                                  Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                                  Asking two questionshellip

                                                                                                                                                                                                                                                                  Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                                                                                  this

                                                                                                                                                                                                                                                                  what

                                                                                                                                                                                                                                                                  I se

                                                                                                                                                                                                                                                                  t out

                                                                                                                                                                                                                                                                  to

                                                                                                                                                                                                                                                                  do

                                                                                                                                                                                                                                                                  bullYesbullYes

                                                                                                                                                                                                                                                                  bullNobullYes

                                                                                                                                                                                                                                                                  bullYesbullNo

                                                                                                                                                                                                                                                                  bullNobullNo

                                                                                                                                                                                                                                                                  Am I having fun nowIs

                                                                                                                                                                                                                                                                  this

                                                                                                                                                                                                                                                                  what

                                                                                                                                                                                                                                                                  I se

                                                                                                                                                                                                                                                                  t out

                                                                                                                                                                                                                                                                  to

                                                                                                                                                                                                                                                                  do

                                                                                                                                                                                                                                                                  bullFunbullOn-task

                                                                                                                                                                                                                                                                  bullNot funbullOn-task

                                                                                                                                                                                                                                                                  bullFunbullNot on-task

                                                                                                                                                                                                                                                                  bullNot funbullNot on-task

                                                                                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                                                                                  Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                                  inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                  Volkow et al 2004

                                                                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                                                                  Quarterly QI review

                                                                                                                                                                                                                                                                  The post-mortem

                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                  Yoga read

                                                                                                                                                                                                                                                                  Staff meeting

                                                                                                                                                                                                                                                                  Planningsession

                                                                                                                                                                                                                                                                  Phone calls

                                                                                                                                                                                                                                                                  billing

                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                  Learn French

                                                                                                                                                                                                                                                                  Stop smoking

                                                                                                                                                                                                                                                                  Be a better spouse

                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                                                                                                                  DavidNowell

                                                                                                                                                                                                                                                                  • Slide 1
                                                                                                                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                                                                                                                  • Slide 3
                                                                                                                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                  • Slide 7
                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                  • Overview
                                                                                                                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                  • Slide 17
                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                  • Slide 19
                                                                                                                                                                                                                                                                  • Strategies
                                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                                                                                  • Slide 23
                                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                  • Slide 25
                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                  • Slide 27
                                                                                                                                                                                                                                                                  • Slide 28
                                                                                                                                                                                                                                                                  • Slide 29
                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                  • Slide 35
                                                                                                                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                                                                                                                  • (C)APD
                                                                                                                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                  • Self-assessment
                                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                  • Slide 42
                                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                  • Core symptoms
                                                                                                                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                  • Slide 53
                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                  • Slide 63
                                                                                                                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                                                                                                                  • Slide 66
                                                                                                                                                                                                                                                                  • Slide 67
                                                                                                                                                                                                                                                                  • ADHD and women
                                                                                                                                                                                                                                                                  • Slide 69
                                                                                                                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                                                                                                                  • Slide 74
                                                                                                                                                                                                                                                                  • Slide 75
                                                                                                                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                  • Slide 84
                                                                                                                                                                                                                                                                  • Slide 85
                                                                                                                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                                                                                                                  • Slide 89
                                                                                                                                                                                                                                                                  • Slide 90
                                                                                                                                                                                                                                                                  • Slide 91
                                                                                                                                                                                                                                                                  • Slide 92
                                                                                                                                                                                                                                                                  • Slide 93
                                                                                                                                                                                                                                                                  • Slide 94
                                                                                                                                                                                                                                                                  • Slide 95
                                                                                                                                                                                                                                                                  • Slide 96
                                                                                                                                                                                                                                                                  • Slide 97
                                                                                                                                                                                                                                                                  • Slide 98
                                                                                                                                                                                                                                                                  • Slide 99
                                                                                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                                                                                  • Slide 101
                                                                                                                                                                                                                                                                  • Slide 102
                                                                                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                                                                                  • Slide 106
                                                                                                                                                                                                                                                                  • Slide 107
                                                                                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                                                                                  • Slide 109
                                                                                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                                                                                  • Time Out
                                                                                                                                                                                                                                                                  • Token economy
                                                                                                                                                                                                                                                                  • Slide 113
                                                                                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                                                                                  • Slide 115
                                                                                                                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                                                                                                                  • Slide 117
                                                                                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                                                                                  • Metacognition
                                                                                                                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                  • Slide 124
                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                  • Slide 128
                                                                                                                                                                                                                                                                  • Slide 129
                                                                                                                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                  • Slide 141
                                                                                                                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                  • Slide 146
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                  • Slide 149
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                  • Slide 152
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                  • Slide 154
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                  • Slide 157
                                                                                                                                                                                                                                                                  • Slide 158
                                                                                                                                                                                                                                                                  • Slide 159
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                  • Slide 162
                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                  • Slide 164
                                                                                                                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                  • Slide 166
                                                                                                                                                                                                                                                                  • Slide 167
                                                                                                                                                                                                                                                                  • Slide 168
                                                                                                                                                                                                                                                                  • Slide 169
                                                                                                                                                                                                                                                                  • Slide 170
                                                                                                                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                  • Match the Picture
                                                                                                                                                                                                                                                                  • Slide 176
                                                                                                                                                                                                                                                                  • Slide 177
                                                                                                                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                                                                                                                  • Slide 179
                                                                                                                                                                                                                                                                  • Slide 180
                                                                                                                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                                                                                                                  • Learning Time
                                                                                                                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                                                                                                                  • Slide 185
                                                                                                                                                                                                                                                                  • Slide 186
                                                                                                                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                                                                                                                  • Slide 189
                                                                                                                                                                                                                                                                  • Slide 190
                                                                                                                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                  • Slide 194
                                                                                                                                                                                                                                                                  • Slide 195
                                                                                                                                                                                                                                                                  • Slide 196
                                                                                                                                                                                                                                                                  • Slide 197
                                                                                                                                                                                                                                                                  • Slide 198
                                                                                                                                                                                                                                                                  • Slide 199
                                                                                                                                                                                                                                                                  • Slide 200
                                                                                                                                                                                                                                                                  • Slide 201
                                                                                                                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                                                                                                                  • The post-mortem
                                                                                                                                                                                                                                                                  • Slide 204
                                                                                                                                                                                                                                                                  • Slide 205
                                                                                                                                                                                                                                                                  • Slide 206
                                                                                                                                                                                                                                                                  • Slide 207
                                                                                                                                                                                                                                                                  • Slide 208
                                                                                                                                                                                                                                                                  • Slide 209
                                                                                                                                                                                                                                                                  • Slide 210
                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                  • Slide 212
                                                                                                                                                                                                                                                                  • Slide 213
                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                  • Slide 215
                                                                                                                                                                                                                                                                  • Slide 216
                                                                                                                                                                                                                                                                  • Slide 217
                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                  • A challengehellip
                                                                                                                                                                                                                                                                  • Slide 222

                                                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                                                    Learning Time

                                                                                                                                                                                                                                                                    Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                                    Asking two questionshellip

                                                                                                                                                                                                                                                                    Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                                                                                    this

                                                                                                                                                                                                                                                                    what

                                                                                                                                                                                                                                                                    I se

                                                                                                                                                                                                                                                                    t out

                                                                                                                                                                                                                                                                    to

                                                                                                                                                                                                                                                                    do

                                                                                                                                                                                                                                                                    bullYesbullYes

                                                                                                                                                                                                                                                                    bullNobullYes

                                                                                                                                                                                                                                                                    bullYesbullNo

                                                                                                                                                                                                                                                                    bullNobullNo

                                                                                                                                                                                                                                                                    Am I having fun nowIs

                                                                                                                                                                                                                                                                    this

                                                                                                                                                                                                                                                                    what

                                                                                                                                                                                                                                                                    I se

                                                                                                                                                                                                                                                                    t out

                                                                                                                                                                                                                                                                    to

                                                                                                                                                                                                                                                                    do

                                                                                                                                                                                                                                                                    bullFunbullOn-task

                                                                                                                                                                                                                                                                    bullNot funbullOn-task

                                                                                                                                                                                                                                                                    bullFunbullNot on-task

                                                                                                                                                                                                                                                                    bullNot funbullNot on-task

                                                                                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                                                                                    Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                                    inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                                    Key Features of Video Games

                                                                                                                                                                                                                                                                    Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                    focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                    Volkow et al 2004

                                                                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                                                                    Quarterly QI review

                                                                                                                                                                                                                                                                    The post-mortem

                                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                                    Yoga read

                                                                                                                                                                                                                                                                    Staff meeting

                                                                                                                                                                                                                                                                    Planningsession

                                                                                                                                                                                                                                                                    Phone calls

                                                                                                                                                                                                                                                                    billing

                                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                                    Learn French

                                                                                                                                                                                                                                                                    Stop smoking

                                                                                                                                                                                                                                                                    Be a better spouse

                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                                                                                                                    DavidNowell

                                                                                                                                                                                                                                                                    • Slide 1
                                                                                                                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                                                                                                                    • Slide 3
                                                                                                                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                    • Slide 7
                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                    • Overview
                                                                                                                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                    • Slide 17
                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                    • Slide 19
                                                                                                                                                                                                                                                                    • Strategies
                                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                                                                                    • Slide 23
                                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                    • Slide 25
                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                    • Slide 27
                                                                                                                                                                                                                                                                    • Slide 28
                                                                                                                                                                                                                                                                    • Slide 29
                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                    • Slide 35
                                                                                                                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                                                                                                                    • (C)APD
                                                                                                                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                    • Self-assessment
                                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                    • Slide 42
                                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                    • Core symptoms
                                                                                                                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                    • Slide 53
                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                    • Slide 63
                                                                                                                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                                                                                                                    • Slide 66
                                                                                                                                                                                                                                                                    • Slide 67
                                                                                                                                                                                                                                                                    • ADHD and women
                                                                                                                                                                                                                                                                    • Slide 69
                                                                                                                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                                                                                                                    • Slide 74
                                                                                                                                                                                                                                                                    • Slide 75
                                                                                                                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                    • Slide 84
                                                                                                                                                                                                                                                                    • Slide 85
                                                                                                                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                                                                                                                    • Slide 89
                                                                                                                                                                                                                                                                    • Slide 90
                                                                                                                                                                                                                                                                    • Slide 91
                                                                                                                                                                                                                                                                    • Slide 92
                                                                                                                                                                                                                                                                    • Slide 93
                                                                                                                                                                                                                                                                    • Slide 94
                                                                                                                                                                                                                                                                    • Slide 95
                                                                                                                                                                                                                                                                    • Slide 96
                                                                                                                                                                                                                                                                    • Slide 97
                                                                                                                                                                                                                                                                    • Slide 98
                                                                                                                                                                                                                                                                    • Slide 99
                                                                                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                                                                                    • Slide 101
                                                                                                                                                                                                                                                                    • Slide 102
                                                                                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                                                                                    • Slide 106
                                                                                                                                                                                                                                                                    • Slide 107
                                                                                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                                                                                    • Slide 109
                                                                                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                                                                                    • Time Out
                                                                                                                                                                                                                                                                    • Token economy
                                                                                                                                                                                                                                                                    • Slide 113
                                                                                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                                                                                    • Slide 115
                                                                                                                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                                                                                                                    • Slide 117
                                                                                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                                                                                    • Metacognition
                                                                                                                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                    • Slide 124
                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                    • Slide 128
                                                                                                                                                                                                                                                                    • Slide 129
                                                                                                                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                    • Slide 141
                                                                                                                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                    • Slide 146
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                    • Slide 149
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                    • Slide 152
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                    • Slide 154
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                    • Slide 157
                                                                                                                                                                                                                                                                    • Slide 158
                                                                                                                                                                                                                                                                    • Slide 159
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                    • Slide 162
                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                    • Slide 164
                                                                                                                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                    • Slide 166
                                                                                                                                                                                                                                                                    • Slide 167
                                                                                                                                                                                                                                                                    • Slide 168
                                                                                                                                                                                                                                                                    • Slide 169
                                                                                                                                                                                                                                                                    • Slide 170
                                                                                                                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                    • Match the Picture
                                                                                                                                                                                                                                                                    • Slide 176
                                                                                                                                                                                                                                                                    • Slide 177
                                                                                                                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                                                                                                                    • Slide 179
                                                                                                                                                                                                                                                                    • Slide 180
                                                                                                                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                                                                                                                    • Learning Time
                                                                                                                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                                                                                                                    • Slide 185
                                                                                                                                                                                                                                                                    • Slide 186
                                                                                                                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                                                                                                                    • Slide 189
                                                                                                                                                                                                                                                                    • Slide 190
                                                                                                                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                    • Slide 194
                                                                                                                                                                                                                                                                    • Slide 195
                                                                                                                                                                                                                                                                    • Slide 196
                                                                                                                                                                                                                                                                    • Slide 197
                                                                                                                                                                                                                                                                    • Slide 198
                                                                                                                                                                                                                                                                    • Slide 199
                                                                                                                                                                                                                                                                    • Slide 200
                                                                                                                                                                                                                                                                    • Slide 201
                                                                                                                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                                                                                                                    • The post-mortem
                                                                                                                                                                                                                                                                    • Slide 204
                                                                                                                                                                                                                                                                    • Slide 205
                                                                                                                                                                                                                                                                    • Slide 206
                                                                                                                                                                                                                                                                    • Slide 207
                                                                                                                                                                                                                                                                    • Slide 208
                                                                                                                                                                                                                                                                    • Slide 209
                                                                                                                                                                                                                                                                    • Slide 210
                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                    • Slide 212
                                                                                                                                                                                                                                                                    • Slide 213
                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                    • Slide 215
                                                                                                                                                                                                                                                                    • Slide 216
                                                                                                                                                                                                                                                                    • Slide 217
                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                    • A challengehellip
                                                                                                                                                                                                                                                                    • Slide 222

                                                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                                                      Learning Time

                                                                                                                                                                                                                                                                      Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                                      Asking two questionshellip

                                                                                                                                                                                                                                                                      Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                                                                                      this

                                                                                                                                                                                                                                                                      what

                                                                                                                                                                                                                                                                      I se

                                                                                                                                                                                                                                                                      t out

                                                                                                                                                                                                                                                                      to

                                                                                                                                                                                                                                                                      do

                                                                                                                                                                                                                                                                      bullYesbullYes

                                                                                                                                                                                                                                                                      bullNobullYes

                                                                                                                                                                                                                                                                      bullYesbullNo

                                                                                                                                                                                                                                                                      bullNobullNo

                                                                                                                                                                                                                                                                      Am I having fun nowIs

                                                                                                                                                                                                                                                                      this

                                                                                                                                                                                                                                                                      what

                                                                                                                                                                                                                                                                      I se

                                                                                                                                                                                                                                                                      t out

                                                                                                                                                                                                                                                                      to

                                                                                                                                                                                                                                                                      do

                                                                                                                                                                                                                                                                      bullFunbullOn-task

                                                                                                                                                                                                                                                                      bullNot funbullOn-task

                                                                                                                                                                                                                                                                      bullFunbullNot on-task

                                                                                                                                                                                                                                                                      bullNot funbullNot on-task

                                                                                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                                                                                      Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                                      inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                                      Key Features of Video Games

                                                                                                                                                                                                                                                                      Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                      focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                      Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                      Volkow et al 2004

                                                                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                                                                      Quarterly QI review

                                                                                                                                                                                                                                                                      The post-mortem

                                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                                      Yoga read

                                                                                                                                                                                                                                                                      Staff meeting

                                                                                                                                                                                                                                                                      Planningsession

                                                                                                                                                                                                                                                                      Phone calls

                                                                                                                                                                                                                                                                      billing

                                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                                      Learn French

                                                                                                                                                                                                                                                                      Stop smoking

                                                                                                                                                                                                                                                                      Be a better spouse

                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                                                                                                                                      DavidNowell

                                                                                                                                                                                                                                                                      • Slide 1
                                                                                                                                                                                                                                                                      • hellipa challenge
                                                                                                                                                                                                                                                                      • Slide 3
                                                                                                                                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                      • Slide 7
                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                      • Overview
                                                                                                                                                                                                                                                                      • This Dense Pudding
                                                                                                                                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                                                                                                      • Developmental considerations
                                                                                                                                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                      • Slide 17
                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                      • Slide 19
                                                                                                                                                                                                                                                                      • Strategies
                                                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                                                                                                      • Slide 23
                                                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                      • Slide 25
                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                      • Slide 27
                                                                                                                                                                                                                                                                      • Slide 28
                                                                                                                                                                                                                                                                      • Slide 29
                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                      • Slide 35
                                                                                                                                                                                                                                                                      • Strategies (2)
                                                                                                                                                                                                                                                                      • (C)APD
                                                                                                                                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                      • Self-assessment
                                                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                      • Slide 42
                                                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                      • Core symptoms
                                                                                                                                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                      • Slide 53
                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                      • Slide 63
                                                                                                                                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                      • ADHD and girls
                                                                                                                                                                                                                                                                      • Slide 66
                                                                                                                                                                                                                                                                      • Slide 67
                                                                                                                                                                                                                                                                      • ADHD and women
                                                                                                                                                                                                                                                                      • Slide 69
                                                                                                                                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                      • The Executive Functions
                                                                                                                                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                                                                                                                                      • Slide 74
                                                                                                                                                                                                                                                                      • Slide 75
                                                                                                                                                                                                                                                                      • Appropriate expectations
                                                                                                                                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                      • Slide 84
                                                                                                                                                                                                                                                                      • Slide 85
                                                                                                                                                                                                                                                                      • Strategies (3)
                                                                                                                                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                                                                                                                                      • Behavioral Supports
                                                                                                                                                                                                                                                                      • Slide 89
                                                                                                                                                                                                                                                                      • Slide 90
                                                                                                                                                                                                                                                                      • Slide 91
                                                                                                                                                                                                                                                                      • Slide 92
                                                                                                                                                                                                                                                                      • Slide 93
                                                                                                                                                                                                                                                                      • Slide 94
                                                                                                                                                                                                                                                                      • Slide 95
                                                                                                                                                                                                                                                                      • Slide 96
                                                                                                                                                                                                                                                                      • Slide 97
                                                                                                                                                                                                                                                                      • Slide 98
                                                                                                                                                                                                                                                                      • Slide 99
                                                                                                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                                                                                                      • Slide 101
                                                                                                                                                                                                                                                                      • Slide 102
                                                                                                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                                                                                                      • Slide 106
                                                                                                                                                                                                                                                                      • Slide 107
                                                                                                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                                                                                                      • Slide 109
                                                                                                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                                                                                                      • Time Out
                                                                                                                                                                                                                                                                      • Token economy
                                                                                                                                                                                                                                                                      • Slide 113
                                                                                                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                                                                                                      • Slide 115
                                                                                                                                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                                                                                                                                      • Slide 117
                                                                                                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                                                                                                      • Metacognition
                                                                                                                                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                      • Slide 124
                                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                      • Slide 128
                                                                                                                                                                                                                                                                      • Slide 129
                                                                                                                                                                                                                                                                      • Broaden and Build
                                                                                                                                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                      • Slide 141
                                                                                                                                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                      • Slide 146
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                      • Slide 149
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                      • Slide 152
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                      • Slide 154
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                      • Slide 157
                                                                                                                                                                                                                                                                      • Slide 158
                                                                                                                                                                                                                                                                      • Slide 159
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                      • Slide 162
                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                      • Slide 164
                                                                                                                                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                      • Slide 166
                                                                                                                                                                                                                                                                      • Slide 167
                                                                                                                                                                                                                                                                      • Slide 168
                                                                                                                                                                                                                                                                      • Slide 169
                                                                                                                                                                                                                                                                      • Slide 170
                                                                                                                                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                      • Match the Picture
                                                                                                                                                                                                                                                                      • Slide 176
                                                                                                                                                                                                                                                                      • Slide 177
                                                                                                                                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                                                                                                                                      • Slide 179
                                                                                                                                                                                                                                                                      • Slide 180
                                                                                                                                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                                                                                                                                      • Learning Time
                                                                                                                                                                                                                                                                      • Learning Time (2)
                                                                                                                                                                                                                                                                      • Learning Time (3)
                                                                                                                                                                                                                                                                      • Slide 185
                                                                                                                                                                                                                                                                      • Slide 186
                                                                                                                                                                                                                                                                      • Learning Time (4)
                                                                                                                                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                                                                                                                                      • Slide 189
                                                                                                                                                                                                                                                                      • Slide 190
                                                                                                                                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                      • Slide 194
                                                                                                                                                                                                                                                                      • Slide 195
                                                                                                                                                                                                                                                                      • Slide 196
                                                                                                                                                                                                                                                                      • Slide 197
                                                                                                                                                                                                                                                                      • Slide 198
                                                                                                                                                                                                                                                                      • Slide 199
                                                                                                                                                                                                                                                                      • Slide 200
                                                                                                                                                                                                                                                                      • Slide 201
                                                                                                                                                                                                                                                                      • Quarterly QI review
                                                                                                                                                                                                                                                                      • The post-mortem
                                                                                                                                                                                                                                                                      • Slide 204
                                                                                                                                                                                                                                                                      • Slide 205
                                                                                                                                                                                                                                                                      • Slide 206
                                                                                                                                                                                                                                                                      • Slide 207
                                                                                                                                                                                                                                                                      • Slide 208
                                                                                                                                                                                                                                                                      • Slide 209
                                                                                                                                                                                                                                                                      • Slide 210
                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                      • Slide 212
                                                                                                                                                                                                                                                                      • Slide 213
                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                      • Slide 215
                                                                                                                                                                                                                                                                      • Slide 216
                                                                                                                                                                                                                                                                      • Slide 217
                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                      • A challengehellip
                                                                                                                                                                                                                                                                      • Slide 222

                                                                                                                                                                                                                                                                        Learning Time

                                                                                                                                                                                                                                                                        Theres no such thing as procrastinationhelliptherersquos just choosing And choosing again

                                                                                                                                                                                                                                                                        Asking two questionshellip

                                                                                                                                                                                                                                                                        Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                                                                                        this

                                                                                                                                                                                                                                                                        what

                                                                                                                                                                                                                                                                        I se

                                                                                                                                                                                                                                                                        t out

                                                                                                                                                                                                                                                                        to

                                                                                                                                                                                                                                                                        do

                                                                                                                                                                                                                                                                        bullYesbullYes

                                                                                                                                                                                                                                                                        bullNobullYes

                                                                                                                                                                                                                                                                        bullYesbullNo

                                                                                                                                                                                                                                                                        bullNobullNo

                                                                                                                                                                                                                                                                        Am I having fun nowIs

                                                                                                                                                                                                                                                                        this

                                                                                                                                                                                                                                                                        what

                                                                                                                                                                                                                                                                        I se

                                                                                                                                                                                                                                                                        t out

                                                                                                                                                                                                                                                                        to

                                                                                                                                                                                                                                                                        do

                                                                                                                                                                                                                                                                        bullFunbullOn-task

                                                                                                                                                                                                                                                                        bullNot funbullOn-task

                                                                                                                                                                                                                                                                        bullFunbullNot on-task

                                                                                                                                                                                                                                                                        bullNot funbullNot on-task

                                                                                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                                                                                        Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                                        inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                                        Key Features of Video Games

                                                                                                                                                                                                                                                                        Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                        focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                        Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                        Volkow et al 2004

                                                                                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                                                                                        Quarterly QI review

                                                                                                                                                                                                                                                                        The post-mortem

                                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                                        Yoga read

                                                                                                                                                                                                                                                                        Staff meeting

                                                                                                                                                                                                                                                                        Planningsession

                                                                                                                                                                                                                                                                        Phone calls

                                                                                                                                                                                                                                                                        billing

                                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                                        Learn French

                                                                                                                                                                                                                                                                        Stop smoking

                                                                                                                                                                                                                                                                        Be a better spouse

                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                                                                                                                                        DavidNowell

                                                                                                                                                                                                                                                                        • Slide 1
                                                                                                                                                                                                                                                                        • hellipa challenge
                                                                                                                                                                                                                                                                        • Slide 3
                                                                                                                                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                        • Slide 7
                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                        • Overview
                                                                                                                                                                                                                                                                        • This Dense Pudding
                                                                                                                                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                                                                                                        • Developmental considerations
                                                                                                                                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                        • Slide 17
                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                        • Slide 19
                                                                                                                                                                                                                                                                        • Strategies
                                                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                                                                                                        • Slide 23
                                                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                        • Slide 25
                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                        • Slide 27
                                                                                                                                                                                                                                                                        • Slide 28
                                                                                                                                                                                                                                                                        • Slide 29
                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                        • Slide 35
                                                                                                                                                                                                                                                                        • Strategies (2)
                                                                                                                                                                                                                                                                        • (C)APD
                                                                                                                                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                        • Self-assessment
                                                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                        • Slide 42
                                                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                        • Core symptoms
                                                                                                                                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                        • Slide 53
                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                        • Slide 63
                                                                                                                                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                        • ADHD and girls
                                                                                                                                                                                                                                                                        • Slide 66
                                                                                                                                                                                                                                                                        • Slide 67
                                                                                                                                                                                                                                                                        • ADHD and women
                                                                                                                                                                                                                                                                        • Slide 69
                                                                                                                                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                        • The Executive Functions
                                                                                                                                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                                                                                                                                        • Slide 74
                                                                                                                                                                                                                                                                        • Slide 75
                                                                                                                                                                                                                                                                        • Appropriate expectations
                                                                                                                                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                        • Slide 84
                                                                                                                                                                                                                                                                        • Slide 85
                                                                                                                                                                                                                                                                        • Strategies (3)
                                                                                                                                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                                                                                                                                        • Behavioral Supports
                                                                                                                                                                                                                                                                        • Slide 89
                                                                                                                                                                                                                                                                        • Slide 90
                                                                                                                                                                                                                                                                        • Slide 91
                                                                                                                                                                                                                                                                        • Slide 92
                                                                                                                                                                                                                                                                        • Slide 93
                                                                                                                                                                                                                                                                        • Slide 94
                                                                                                                                                                                                                                                                        • Slide 95
                                                                                                                                                                                                                                                                        • Slide 96
                                                                                                                                                                                                                                                                        • Slide 97
                                                                                                                                                                                                                                                                        • Slide 98
                                                                                                                                                                                                                                                                        • Slide 99
                                                                                                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                                                                                                        • Slide 101
                                                                                                                                                                                                                                                                        • Slide 102
                                                                                                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                                                                                                        • Slide 106
                                                                                                                                                                                                                                                                        • Slide 107
                                                                                                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                                                                                                        • Slide 109
                                                                                                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                                                                                                        • Time Out
                                                                                                                                                                                                                                                                        • Token economy
                                                                                                                                                                                                                                                                        • Slide 113
                                                                                                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                                                                                                        • Slide 115
                                                                                                                                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                                                                                                                                        • Slide 117
                                                                                                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                                                                                                        • Metacognition
                                                                                                                                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                        • Slide 124
                                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                        • Slide 128
                                                                                                                                                                                                                                                                        • Slide 129
                                                                                                                                                                                                                                                                        • Broaden and Build
                                                                                                                                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                        • Slide 141
                                                                                                                                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                        • Slide 146
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                        • Slide 149
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                        • Slide 152
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                        • Slide 154
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                        • Slide 157
                                                                                                                                                                                                                                                                        • Slide 158
                                                                                                                                                                                                                                                                        • Slide 159
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                        • Slide 162
                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                        • Slide 164
                                                                                                                                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                        • Slide 166
                                                                                                                                                                                                                                                                        • Slide 167
                                                                                                                                                                                                                                                                        • Slide 168
                                                                                                                                                                                                                                                                        • Slide 169
                                                                                                                                                                                                                                                                        • Slide 170
                                                                                                                                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                        • Match the Picture
                                                                                                                                                                                                                                                                        • Slide 176
                                                                                                                                                                                                                                                                        • Slide 177
                                                                                                                                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                                                                                                                                        • Slide 179
                                                                                                                                                                                                                                                                        • Slide 180
                                                                                                                                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                                                                                                                                        • Learning Time
                                                                                                                                                                                                                                                                        • Learning Time (2)
                                                                                                                                                                                                                                                                        • Learning Time (3)
                                                                                                                                                                                                                                                                        • Slide 185
                                                                                                                                                                                                                                                                        • Slide 186
                                                                                                                                                                                                                                                                        • Learning Time (4)
                                                                                                                                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                                                                                                                                        • Slide 189
                                                                                                                                                                                                                                                                        • Slide 190
                                                                                                                                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                        • Slide 194
                                                                                                                                                                                                                                                                        • Slide 195
                                                                                                                                                                                                                                                                        • Slide 196
                                                                                                                                                                                                                                                                        • Slide 197
                                                                                                                                                                                                                                                                        • Slide 198
                                                                                                                                                                                                                                                                        • Slide 199
                                                                                                                                                                                                                                                                        • Slide 200
                                                                                                                                                                                                                                                                        • Slide 201
                                                                                                                                                                                                                                                                        • Quarterly QI review
                                                                                                                                                                                                                                                                        • The post-mortem
                                                                                                                                                                                                                                                                        • Slide 204
                                                                                                                                                                                                                                                                        • Slide 205
                                                                                                                                                                                                                                                                        • Slide 206
                                                                                                                                                                                                                                                                        • Slide 207
                                                                                                                                                                                                                                                                        • Slide 208
                                                                                                                                                                                                                                                                        • Slide 209
                                                                                                                                                                                                                                                                        • Slide 210
                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                        • Slide 212
                                                                                                                                                                                                                                                                        • Slide 213
                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                        • Slide 215
                                                                                                                                                                                                                                                                        • Slide 216
                                                                                                                                                                                                                                                                        • Slide 217
                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                        • A challengehellip
                                                                                                                                                                                                                                                                        • Slide 222

                                                                                                                                                                                                                                                                          Asking two questionshellip

                                                                                                                                                                                                                                                                          Am I having fun now And is this what I set out to do

                                                                                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                                                                                          this

                                                                                                                                                                                                                                                                          what

                                                                                                                                                                                                                                                                          I se

                                                                                                                                                                                                                                                                          t out

                                                                                                                                                                                                                                                                          to

                                                                                                                                                                                                                                                                          do

                                                                                                                                                                                                                                                                          bullYesbullYes

                                                                                                                                                                                                                                                                          bullNobullYes

                                                                                                                                                                                                                                                                          bullYesbullNo

                                                                                                                                                                                                                                                                          bullNobullNo

                                                                                                                                                                                                                                                                          Am I having fun nowIs

                                                                                                                                                                                                                                                                          this

                                                                                                                                                                                                                                                                          what

                                                                                                                                                                                                                                                                          I se

                                                                                                                                                                                                                                                                          t out

                                                                                                                                                                                                                                                                          to

                                                                                                                                                                                                                                                                          do

                                                                                                                                                                                                                                                                          bullFunbullOn-task

                                                                                                                                                                                                                                                                          bullNot funbullOn-task

                                                                                                                                                                                                                                                                          bullFunbullNot on-task

                                                                                                                                                                                                                                                                          bullNot funbullNot on-task

                                                                                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                                                                                          Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                                          inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                                          Key Features of Video Games

                                                                                                                                                                                                                                                                          Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                          focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                          Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                          Volkow et al 2004

                                                                                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                                                                                          Increase salience

                                                                                                                                                                                                                                                                          Quarterly QI review

                                                                                                                                                                                                                                                                          The post-mortem

                                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                                          Yoga read

                                                                                                                                                                                                                                                                          Staff meeting

                                                                                                                                                                                                                                                                          Planningsession

                                                                                                                                                                                                                                                                          Phone calls

                                                                                                                                                                                                                                                                          billing

                                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                                          Learn French

                                                                                                                                                                                                                                                                          Stop smoking

                                                                                                                                                                                                                                                                          Be a better spouse

                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                                                                                                                                          DavidNowell

                                                                                                                                                                                                                                                                          • Slide 1
                                                                                                                                                                                                                                                                          • hellipa challenge
                                                                                                                                                                                                                                                                          • Slide 3
                                                                                                                                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                          • Slide 7
                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                          • Overview
                                                                                                                                                                                                                                                                          • This Dense Pudding
                                                                                                                                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                                                                                                          • Developmental considerations
                                                                                                                                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                          • Slide 17
                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                          • Slide 19
                                                                                                                                                                                                                                                                          • Strategies
                                                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                                                                                                          • Slide 23
                                                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                          • Slide 25
                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                          • Slide 27
                                                                                                                                                                                                                                                                          • Slide 28
                                                                                                                                                                                                                                                                          • Slide 29
                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                          • Slide 35
                                                                                                                                                                                                                                                                          • Strategies (2)
                                                                                                                                                                                                                                                                          • (C)APD
                                                                                                                                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                          • Self-assessment
                                                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                          • Slide 42
                                                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                          • Core symptoms
                                                                                                                                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                          • Slide 53
                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                          • Slide 63
                                                                                                                                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                          • ADHD and girls
                                                                                                                                                                                                                                                                          • Slide 66
                                                                                                                                                                                                                                                                          • Slide 67
                                                                                                                                                                                                                                                                          • ADHD and women
                                                                                                                                                                                                                                                                          • Slide 69
                                                                                                                                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                          • The Executive Functions
                                                                                                                                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                                                                                                                                          • Slide 74
                                                                                                                                                                                                                                                                          • Slide 75
                                                                                                                                                                                                                                                                          • Appropriate expectations
                                                                                                                                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                          • Slide 84
                                                                                                                                                                                                                                                                          • Slide 85
                                                                                                                                                                                                                                                                          • Strategies (3)
                                                                                                                                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                                                                                                                                          • Behavioral Supports
                                                                                                                                                                                                                                                                          • Slide 89
                                                                                                                                                                                                                                                                          • Slide 90
                                                                                                                                                                                                                                                                          • Slide 91
                                                                                                                                                                                                                                                                          • Slide 92
                                                                                                                                                                                                                                                                          • Slide 93
                                                                                                                                                                                                                                                                          • Slide 94
                                                                                                                                                                                                                                                                          • Slide 95
                                                                                                                                                                                                                                                                          • Slide 96
                                                                                                                                                                                                                                                                          • Slide 97
                                                                                                                                                                                                                                                                          • Slide 98
                                                                                                                                                                                                                                                                          • Slide 99
                                                                                                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                                                                                                          • Slide 101
                                                                                                                                                                                                                                                                          • Slide 102
                                                                                                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                                                                                                          • Slide 106
                                                                                                                                                                                                                                                                          • Slide 107
                                                                                                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                                                                                                          • Slide 109
                                                                                                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                                                                                                          • Time Out
                                                                                                                                                                                                                                                                          • Token economy
                                                                                                                                                                                                                                                                          • Slide 113
                                                                                                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                                                                                                          • Slide 115
                                                                                                                                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                                                                                                                                          • Slide 117
                                                                                                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                                                                                                          • Metacognition
                                                                                                                                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                          • Slide 124
                                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                          • Slide 128
                                                                                                                                                                                                                                                                          • Slide 129
                                                                                                                                                                                                                                                                          • Broaden and Build
                                                                                                                                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                          • Slide 141
                                                                                                                                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                          • Slide 146
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                          • Slide 149
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                          • Slide 152
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                          • Slide 154
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                          • Slide 157
                                                                                                                                                                                                                                                                          • Slide 158
                                                                                                                                                                                                                                                                          • Slide 159
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                          • Slide 162
                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                          • Slide 164
                                                                                                                                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                          • Slide 166
                                                                                                                                                                                                                                                                          • Slide 167
                                                                                                                                                                                                                                                                          • Slide 168
                                                                                                                                                                                                                                                                          • Slide 169
                                                                                                                                                                                                                                                                          • Slide 170
                                                                                                                                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                          • Match the Picture
                                                                                                                                                                                                                                                                          • Slide 176
                                                                                                                                                                                                                                                                          • Slide 177
                                                                                                                                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                                                                                                                                          • Slide 179
                                                                                                                                                                                                                                                                          • Slide 180
                                                                                                                                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                                                                                                                                          • Learning Time
                                                                                                                                                                                                                                                                          • Learning Time (2)
                                                                                                                                                                                                                                                                          • Learning Time (3)
                                                                                                                                                                                                                                                                          • Slide 185
                                                                                                                                                                                                                                                                          • Slide 186
                                                                                                                                                                                                                                                                          • Learning Time (4)
                                                                                                                                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                                                                                                                                          • Slide 189
                                                                                                                                                                                                                                                                          • Slide 190
                                                                                                                                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                          • Slide 194
                                                                                                                                                                                                                                                                          • Slide 195
                                                                                                                                                                                                                                                                          • Slide 196
                                                                                                                                                                                                                                                                          • Slide 197
                                                                                                                                                                                                                                                                          • Slide 198
                                                                                                                                                                                                                                                                          • Slide 199
                                                                                                                                                                                                                                                                          • Slide 200
                                                                                                                                                                                                                                                                          • Slide 201
                                                                                                                                                                                                                                                                          • Quarterly QI review
                                                                                                                                                                                                                                                                          • The post-mortem
                                                                                                                                                                                                                                                                          • Slide 204
                                                                                                                                                                                                                                                                          • Slide 205
                                                                                                                                                                                                                                                                          • Slide 206
                                                                                                                                                                                                                                                                          • Slide 207
                                                                                                                                                                                                                                                                          • Slide 208
                                                                                                                                                                                                                                                                          • Slide 209
                                                                                                                                                                                                                                                                          • Slide 210
                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                          • Slide 212
                                                                                                                                                                                                                                                                          • Slide 213
                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                          • Slide 215
                                                                                                                                                                                                                                                                          • Slide 216
                                                                                                                                                                                                                                                                          • Slide 217
                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                          • A challengehellip
                                                                                                                                                                                                                                                                          • Slide 222

                                                                                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                                                                                            this

                                                                                                                                                                                                                                                                            what

                                                                                                                                                                                                                                                                            I se

                                                                                                                                                                                                                                                                            t out

                                                                                                                                                                                                                                                                            to

                                                                                                                                                                                                                                                                            do

                                                                                                                                                                                                                                                                            bullYesbullYes

                                                                                                                                                                                                                                                                            bullNobullYes

                                                                                                                                                                                                                                                                            bullYesbullNo

                                                                                                                                                                                                                                                                            bullNobullNo

                                                                                                                                                                                                                                                                            Am I having fun nowIs

                                                                                                                                                                                                                                                                            this

                                                                                                                                                                                                                                                                            what

                                                                                                                                                                                                                                                                            I se

                                                                                                                                                                                                                                                                            t out

                                                                                                                                                                                                                                                                            to

                                                                                                                                                                                                                                                                            do

                                                                                                                                                                                                                                                                            bullFunbullOn-task

                                                                                                                                                                                                                                                                            bullNot funbullOn-task

                                                                                                                                                                                                                                                                            bullFunbullNot on-task

                                                                                                                                                                                                                                                                            bullNot funbullNot on-task

                                                                                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                                                                                            Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                                            inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                                            Key Features of Video Games

                                                                                                                                                                                                                                                                            Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                            focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                            Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                            Volkow et al 2004

                                                                                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                                                                                            Increase salience

                                                                                                                                                                                                                                                                            Quarterly QI review

                                                                                                                                                                                                                                                                            The post-mortem

                                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                                            Yoga read

                                                                                                                                                                                                                                                                            Staff meeting

                                                                                                                                                                                                                                                                            Planningsession

                                                                                                                                                                                                                                                                            Phone calls

                                                                                                                                                                                                                                                                            billing

                                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                                            Learn French

                                                                                                                                                                                                                                                                            Stop smoking

                                                                                                                                                                                                                                                                            Be a better spouse

                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                                                                                                                                            DavidNowell

                                                                                                                                                                                                                                                                            • Slide 1
                                                                                                                                                                                                                                                                            • hellipa challenge
                                                                                                                                                                                                                                                                            • Slide 3
                                                                                                                                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                            • Slide 7
                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                            • Overview
                                                                                                                                                                                                                                                                            • This Dense Pudding
                                                                                                                                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                                                                                                            • Developmental considerations
                                                                                                                                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                            • Slide 17
                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                            • Slide 19
                                                                                                                                                                                                                                                                            • Strategies
                                                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                                                                                                            • Slide 23
                                                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                            • Slide 25
                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                            • Slide 27
                                                                                                                                                                                                                                                                            • Slide 28
                                                                                                                                                                                                                                                                            • Slide 29
                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                            • Slide 35
                                                                                                                                                                                                                                                                            • Strategies (2)
                                                                                                                                                                                                                                                                            • (C)APD
                                                                                                                                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                            • Self-assessment
                                                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                            • Slide 42
                                                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                            • Core symptoms
                                                                                                                                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                            • Slide 53
                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                            • Slide 63
                                                                                                                                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                            • ADHD and girls
                                                                                                                                                                                                                                                                            • Slide 66
                                                                                                                                                                                                                                                                            • Slide 67
                                                                                                                                                                                                                                                                            • ADHD and women
                                                                                                                                                                                                                                                                            • Slide 69
                                                                                                                                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                            • The Executive Functions
                                                                                                                                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                                                                                                                                            • Slide 74
                                                                                                                                                                                                                                                                            • Slide 75
                                                                                                                                                                                                                                                                            • Appropriate expectations
                                                                                                                                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                            • Slide 84
                                                                                                                                                                                                                                                                            • Slide 85
                                                                                                                                                                                                                                                                            • Strategies (3)
                                                                                                                                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                                                                                                                                            • Behavioral Supports
                                                                                                                                                                                                                                                                            • Slide 89
                                                                                                                                                                                                                                                                            • Slide 90
                                                                                                                                                                                                                                                                            • Slide 91
                                                                                                                                                                                                                                                                            • Slide 92
                                                                                                                                                                                                                                                                            • Slide 93
                                                                                                                                                                                                                                                                            • Slide 94
                                                                                                                                                                                                                                                                            • Slide 95
                                                                                                                                                                                                                                                                            • Slide 96
                                                                                                                                                                                                                                                                            • Slide 97
                                                                                                                                                                                                                                                                            • Slide 98
                                                                                                                                                                                                                                                                            • Slide 99
                                                                                                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                                                                                                            • Slide 101
                                                                                                                                                                                                                                                                            • Slide 102
                                                                                                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                                                                                                            • Slide 106
                                                                                                                                                                                                                                                                            • Slide 107
                                                                                                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                                                                                                            • Slide 109
                                                                                                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                                                                                                            • Time Out
                                                                                                                                                                                                                                                                            • Token economy
                                                                                                                                                                                                                                                                            • Slide 113
                                                                                                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                                                                                                            • Slide 115
                                                                                                                                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                                                                                                                                            • Slide 117
                                                                                                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                                                                                                            • Metacognition
                                                                                                                                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                            • Slide 124
                                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                            • Slide 128
                                                                                                                                                                                                                                                                            • Slide 129
                                                                                                                                                                                                                                                                            • Broaden and Build
                                                                                                                                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                            • Slide 141
                                                                                                                                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                            • Slide 146
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                            • Slide 149
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                            • Slide 152
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                            • Slide 154
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                            • Slide 157
                                                                                                                                                                                                                                                                            • Slide 158
                                                                                                                                                                                                                                                                            • Slide 159
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                            • Slide 162
                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                            • Slide 164
                                                                                                                                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                            • Slide 166
                                                                                                                                                                                                                                                                            • Slide 167
                                                                                                                                                                                                                                                                            • Slide 168
                                                                                                                                                                                                                                                                            • Slide 169
                                                                                                                                                                                                                                                                            • Slide 170
                                                                                                                                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                            • Match the Picture
                                                                                                                                                                                                                                                                            • Slide 176
                                                                                                                                                                                                                                                                            • Slide 177
                                                                                                                                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                                                                                                                                            • Slide 179
                                                                                                                                                                                                                                                                            • Slide 180
                                                                                                                                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                                                                                                                                            • Learning Time
                                                                                                                                                                                                                                                                            • Learning Time (2)
                                                                                                                                                                                                                                                                            • Learning Time (3)
                                                                                                                                                                                                                                                                            • Slide 185
                                                                                                                                                                                                                                                                            • Slide 186
                                                                                                                                                                                                                                                                            • Learning Time (4)
                                                                                                                                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                                                                                                                                            • Slide 189
                                                                                                                                                                                                                                                                            • Slide 190
                                                                                                                                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                            • Slide 194
                                                                                                                                                                                                                                                                            • Slide 195
                                                                                                                                                                                                                                                                            • Slide 196
                                                                                                                                                                                                                                                                            • Slide 197
                                                                                                                                                                                                                                                                            • Slide 198
                                                                                                                                                                                                                                                                            • Slide 199
                                                                                                                                                                                                                                                                            • Slide 200
                                                                                                                                                                                                                                                                            • Slide 201
                                                                                                                                                                                                                                                                            • Quarterly QI review
                                                                                                                                                                                                                                                                            • The post-mortem
                                                                                                                                                                                                                                                                            • Slide 204
                                                                                                                                                                                                                                                                            • Slide 205
                                                                                                                                                                                                                                                                            • Slide 206
                                                                                                                                                                                                                                                                            • Slide 207
                                                                                                                                                                                                                                                                            • Slide 208
                                                                                                                                                                                                                                                                            • Slide 209
                                                                                                                                                                                                                                                                            • Slide 210
                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                            • Slide 212
                                                                                                                                                                                                                                                                            • Slide 213
                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                            • Slide 215
                                                                                                                                                                                                                                                                            • Slide 216
                                                                                                                                                                                                                                                                            • Slide 217
                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                            • A challengehellip
                                                                                                                                                                                                                                                                            • Slide 222

                                                                                                                                                                                                                                                                              Am I having fun nowIs

                                                                                                                                                                                                                                                                              this

                                                                                                                                                                                                                                                                              what

                                                                                                                                                                                                                                                                              I se

                                                                                                                                                                                                                                                                              t out

                                                                                                                                                                                                                                                                              to

                                                                                                                                                                                                                                                                              do

                                                                                                                                                                                                                                                                              bullFunbullOn-task

                                                                                                                                                                                                                                                                              bullNot funbullOn-task

                                                                                                                                                                                                                                                                              bullFunbullNot on-task

                                                                                                                                                                                                                                                                              bullNot funbullNot on-task

                                                                                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                                                                                              Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                                              inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                                              Key Features of Video Games

                                                                                                                                                                                                                                                                              Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                              focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                              Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                              Volkow et al 2004

                                                                                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                                                                                              Increase salience

                                                                                                                                                                                                                                                                              Quarterly QI review

                                                                                                                                                                                                                                                                              The post-mortem

                                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                                              Yoga read

                                                                                                                                                                                                                                                                              Staff meeting

                                                                                                                                                                                                                                                                              Planningsession

                                                                                                                                                                                                                                                                              Phone calls

                                                                                                                                                                                                                                                                              billing

                                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                                              Learn French

                                                                                                                                                                                                                                                                              Stop smoking

                                                                                                                                                                                                                                                                              Be a better spouse

                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                                                                                                                                              DavidNowell

                                                                                                                                                                                                                                                                              • Slide 1
                                                                                                                                                                                                                                                                              • hellipa challenge
                                                                                                                                                                                                                                                                              • Slide 3
                                                                                                                                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                              • Slide 7
                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                              • Overview
                                                                                                                                                                                                                                                                              • This Dense Pudding
                                                                                                                                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                                                                                                              • Developmental considerations
                                                                                                                                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                              • Slide 17
                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                              • Slide 19
                                                                                                                                                                                                                                                                              • Strategies
                                                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                                                                                                              • Slide 23
                                                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                              • Slide 25
                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                              • Slide 27
                                                                                                                                                                                                                                                                              • Slide 28
                                                                                                                                                                                                                                                                              • Slide 29
                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                              • Slide 35
                                                                                                                                                                                                                                                                              • Strategies (2)
                                                                                                                                                                                                                                                                              • (C)APD
                                                                                                                                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                              • Self-assessment
                                                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                              • Slide 42
                                                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                              • Core symptoms
                                                                                                                                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                              • Slide 53
                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                              • Slide 63
                                                                                                                                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                              • ADHD and girls
                                                                                                                                                                                                                                                                              • Slide 66
                                                                                                                                                                                                                                                                              • Slide 67
                                                                                                                                                                                                                                                                              • ADHD and women
                                                                                                                                                                                                                                                                              • Slide 69
                                                                                                                                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                              • The Executive Functions
                                                                                                                                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                                                                                                                                              • Slide 74
                                                                                                                                                                                                                                                                              • Slide 75
                                                                                                                                                                                                                                                                              • Appropriate expectations
                                                                                                                                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                              • Slide 84
                                                                                                                                                                                                                                                                              • Slide 85
                                                                                                                                                                                                                                                                              • Strategies (3)
                                                                                                                                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                                                                                                                                              • Behavioral Supports
                                                                                                                                                                                                                                                                              • Slide 89
                                                                                                                                                                                                                                                                              • Slide 90
                                                                                                                                                                                                                                                                              • Slide 91
                                                                                                                                                                                                                                                                              • Slide 92
                                                                                                                                                                                                                                                                              • Slide 93
                                                                                                                                                                                                                                                                              • Slide 94
                                                                                                                                                                                                                                                                              • Slide 95
                                                                                                                                                                                                                                                                              • Slide 96
                                                                                                                                                                                                                                                                              • Slide 97
                                                                                                                                                                                                                                                                              • Slide 98
                                                                                                                                                                                                                                                                              • Slide 99
                                                                                                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                                                                                                              • Slide 101
                                                                                                                                                                                                                                                                              • Slide 102
                                                                                                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                                                                                                              • Slide 106
                                                                                                                                                                                                                                                                              • Slide 107
                                                                                                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                                                                                                              • Slide 109
                                                                                                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                                                                                                              • Time Out
                                                                                                                                                                                                                                                                              • Token economy
                                                                                                                                                                                                                                                                              • Slide 113
                                                                                                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                                                                                                              • Slide 115
                                                                                                                                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                                                                                                                                              • Slide 117
                                                                                                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                                                                                                              • Metacognition
                                                                                                                                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                              • Slide 124
                                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                              • Slide 128
                                                                                                                                                                                                                                                                              • Slide 129
                                                                                                                                                                                                                                                                              • Broaden and Build
                                                                                                                                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                              • Slide 141
                                                                                                                                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                              • Slide 146
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                              • Slide 149
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                              • Slide 152
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                              • Slide 154
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                              • Slide 157
                                                                                                                                                                                                                                                                              • Slide 158
                                                                                                                                                                                                                                                                              • Slide 159
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                              • Slide 162
                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                              • Slide 164
                                                                                                                                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                              • Slide 166
                                                                                                                                                                                                                                                                              • Slide 167
                                                                                                                                                                                                                                                                              • Slide 168
                                                                                                                                                                                                                                                                              • Slide 169
                                                                                                                                                                                                                                                                              • Slide 170
                                                                                                                                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                              • Match the Picture
                                                                                                                                                                                                                                                                              • Slide 176
                                                                                                                                                                                                                                                                              • Slide 177
                                                                                                                                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                                                                                                                                              • Slide 179
                                                                                                                                                                                                                                                                              • Slide 180
                                                                                                                                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                                                                                                                                              • Learning Time
                                                                                                                                                                                                                                                                              • Learning Time (2)
                                                                                                                                                                                                                                                                              • Learning Time (3)
                                                                                                                                                                                                                                                                              • Slide 185
                                                                                                                                                                                                                                                                              • Slide 186
                                                                                                                                                                                                                                                                              • Learning Time (4)
                                                                                                                                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                                                                                                                                              • Slide 189
                                                                                                                                                                                                                                                                              • Slide 190
                                                                                                                                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                              • Slide 194
                                                                                                                                                                                                                                                                              • Slide 195
                                                                                                                                                                                                                                                                              • Slide 196
                                                                                                                                                                                                                                                                              • Slide 197
                                                                                                                                                                                                                                                                              • Slide 198
                                                                                                                                                                                                                                                                              • Slide 199
                                                                                                                                                                                                                                                                              • Slide 200
                                                                                                                                                                                                                                                                              • Slide 201
                                                                                                                                                                                                                                                                              • Quarterly QI review
                                                                                                                                                                                                                                                                              • The post-mortem
                                                                                                                                                                                                                                                                              • Slide 204
                                                                                                                                                                                                                                                                              • Slide 205
                                                                                                                                                                                                                                                                              • Slide 206
                                                                                                                                                                                                                                                                              • Slide 207
                                                                                                                                                                                                                                                                              • Slide 208
                                                                                                                                                                                                                                                                              • Slide 209
                                                                                                                                                                                                                                                                              • Slide 210
                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                              • Slide 212
                                                                                                                                                                                                                                                                              • Slide 213
                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                              • Slide 215
                                                                                                                                                                                                                                                                              • Slide 216
                                                                                                                                                                                                                                                                              • Slide 217
                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                              • A challengehellip
                                                                                                                                                                                                                                                                              • Slide 222

                                                                                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                                                                                Clear expectations Behavioral specificity Build on small changes in behavior Irrelevant behaviors ignored Reward appropriate behavior and punish

                                                                                                                                                                                                                                                                                inappropriate behavior ndash never reverse this

                                                                                                                                                                                                                                                                                Key Features of Video Games

                                                                                                                                                                                                                                                                                Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                                focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                                Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                                Volkow et al 2004

                                                                                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                                                                                Increase salience

                                                                                                                                                                                                                                                                                Quarterly QI review

                                                                                                                                                                                                                                                                                The post-mortem

                                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                Yoga read

                                                                                                                                                                                                                                                                                Staff meeting

                                                                                                                                                                                                                                                                                Planningsession

                                                                                                                                                                                                                                                                                Phone calls

                                                                                                                                                                                                                                                                                billing

                                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                Learn French

                                                                                                                                                                                                                                                                                Stop smoking

                                                                                                                                                                                                                                                                                Be a better spouse

                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                                                                                                                                DavidNowell

                                                                                                                                                                                                                                                                                • Slide 1
                                                                                                                                                                                                                                                                                • hellipa challenge
                                                                                                                                                                                                                                                                                • Slide 3
                                                                                                                                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                • Slide 7
                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                • Overview
                                                                                                                                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                                                                                                • Developmental considerations
                                                                                                                                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                • Slide 17
                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                • Slide 19
                                                                                                                                                                                                                                                                                • Strategies
                                                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                                                                                                • Slide 23
                                                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                • Slide 25
                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                • Slide 27
                                                                                                                                                                                                                                                                                • Slide 28
                                                                                                                                                                                                                                                                                • Slide 29
                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                • Slide 35
                                                                                                                                                                                                                                                                                • Strategies (2)
                                                                                                                                                                                                                                                                                • (C)APD
                                                                                                                                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                • Self-assessment
                                                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                • Slide 42
                                                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                • Core symptoms
                                                                                                                                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                • Slide 53
                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                • Slide 63
                                                                                                                                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                • ADHD and girls
                                                                                                                                                                                                                                                                                • Slide 66
                                                                                                                                                                                                                                                                                • Slide 67
                                                                                                                                                                                                                                                                                • ADHD and women
                                                                                                                                                                                                                                                                                • Slide 69
                                                                                                                                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                • The Executive Functions
                                                                                                                                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                                                                                                                                • Slide 74
                                                                                                                                                                                                                                                                                • Slide 75
                                                                                                                                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                • Slide 84
                                                                                                                                                                                                                                                                                • Slide 85
                                                                                                                                                                                                                                                                                • Strategies (3)
                                                                                                                                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                                                                                                                                • Slide 89
                                                                                                                                                                                                                                                                                • Slide 90
                                                                                                                                                                                                                                                                                • Slide 91
                                                                                                                                                                                                                                                                                • Slide 92
                                                                                                                                                                                                                                                                                • Slide 93
                                                                                                                                                                                                                                                                                • Slide 94
                                                                                                                                                                                                                                                                                • Slide 95
                                                                                                                                                                                                                                                                                • Slide 96
                                                                                                                                                                                                                                                                                • Slide 97
                                                                                                                                                                                                                                                                                • Slide 98
                                                                                                                                                                                                                                                                                • Slide 99
                                                                                                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                                                                                                • Slide 101
                                                                                                                                                                                                                                                                                • Slide 102
                                                                                                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                                                                                                • Slide 106
                                                                                                                                                                                                                                                                                • Slide 107
                                                                                                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                                                                                                • Slide 109
                                                                                                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                                                                                                • Time Out
                                                                                                                                                                                                                                                                                • Token economy
                                                                                                                                                                                                                                                                                • Slide 113
                                                                                                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                                                                                                • Slide 115
                                                                                                                                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                                                                                                                                • Slide 117
                                                                                                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                                                                                                • Metacognition
                                                                                                                                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                • Slide 124
                                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                • Slide 128
                                                                                                                                                                                                                                                                                • Slide 129
                                                                                                                                                                                                                                                                                • Broaden and Build
                                                                                                                                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                • Slide 141
                                                                                                                                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                • Slide 146
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                • Slide 149
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                • Slide 152
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                • Slide 154
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                • Slide 157
                                                                                                                                                                                                                                                                                • Slide 158
                                                                                                                                                                                                                                                                                • Slide 159
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                • Slide 162
                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                • Slide 164
                                                                                                                                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                • Slide 166
                                                                                                                                                                                                                                                                                • Slide 167
                                                                                                                                                                                                                                                                                • Slide 168
                                                                                                                                                                                                                                                                                • Slide 169
                                                                                                                                                                                                                                                                                • Slide 170
                                                                                                                                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                • Match the Picture
                                                                                                                                                                                                                                                                                • Slide 176
                                                                                                                                                                                                                                                                                • Slide 177
                                                                                                                                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                                                                                                                                • Slide 179
                                                                                                                                                                                                                                                                                • Slide 180
                                                                                                                                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                                                                                                                                • Learning Time
                                                                                                                                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                                                                                                                                • Slide 185
                                                                                                                                                                                                                                                                                • Slide 186
                                                                                                                                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                                                                                                                                • Slide 189
                                                                                                                                                                                                                                                                                • Slide 190
                                                                                                                                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                • Slide 194
                                                                                                                                                                                                                                                                                • Slide 195
                                                                                                                                                                                                                                                                                • Slide 196
                                                                                                                                                                                                                                                                                • Slide 197
                                                                                                                                                                                                                                                                                • Slide 198
                                                                                                                                                                                                                                                                                • Slide 199
                                                                                                                                                                                                                                                                                • Slide 200
                                                                                                                                                                                                                                                                                • Slide 201
                                                                                                                                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                                                                                                                                • The post-mortem
                                                                                                                                                                                                                                                                                • Slide 204
                                                                                                                                                                                                                                                                                • Slide 205
                                                                                                                                                                                                                                                                                • Slide 206
                                                                                                                                                                                                                                                                                • Slide 207
                                                                                                                                                                                                                                                                                • Slide 208
                                                                                                                                                                                                                                                                                • Slide 209
                                                                                                                                                                                                                                                                                • Slide 210
                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                • Slide 212
                                                                                                                                                                                                                                                                                • Slide 213
                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                • Slide 215
                                                                                                                                                                                                                                                                                • Slide 216
                                                                                                                                                                                                                                                                                • Slide 217
                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                • A challengehellip
                                                                                                                                                                                                                                                                                • Slide 222

                                                                                                                                                                                                                                                                                  Key Features of Video Games

                                                                                                                                                                                                                                                                                  Always follow up on rules no exceptions Consequences are immediate Punishment is mild Stimuli are exciting and multi-sensory Conduct expensive and time-consuming

                                                                                                                                                                                                                                                                                  focus groups to determine what really ldquograbs lsquoemrdquo

                                                                                                                                                                                                                                                                                  Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                                  Volkow et al 2004

                                                                                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                                                                                  Increase salience

                                                                                                                                                                                                                                                                                  Quarterly QI review

                                                                                                                                                                                                                                                                                  The post-mortem

                                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                  Yoga read

                                                                                                                                                                                                                                                                                  Staff meeting

                                                                                                                                                                                                                                                                                  Planningsession

                                                                                                                                                                                                                                                                                  Phone calls

                                                                                                                                                                                                                                                                                  billing

                                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                  Learn French

                                                                                                                                                                                                                                                                                  Stop smoking

                                                                                                                                                                                                                                                                                  Be a better spouse

                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                                                                                                                                  DavidNowell

                                                                                                                                                                                                                                                                                  • Slide 1
                                                                                                                                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                                                                                                                                  • Slide 3
                                                                                                                                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                  • Slide 7
                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                  • Overview
                                                                                                                                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                  • Slide 17
                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                  • Slide 19
                                                                                                                                                                                                                                                                                  • Strategies
                                                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                                                                                                  • Slide 23
                                                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                  • Slide 25
                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                  • Slide 27
                                                                                                                                                                                                                                                                                  • Slide 28
                                                                                                                                                                                                                                                                                  • Slide 29
                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                  • Slide 35
                                                                                                                                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                                                                                                                                  • (C)APD
                                                                                                                                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                  • Self-assessment
                                                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                  • Slide 42
                                                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                  • Core symptoms
                                                                                                                                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                  • Slide 53
                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                  • Slide 63
                                                                                                                                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                                                                                                                                  • Slide 66
                                                                                                                                                                                                                                                                                  • Slide 67
                                                                                                                                                                                                                                                                                  • ADHD and women
                                                                                                                                                                                                                                                                                  • Slide 69
                                                                                                                                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                                                                                                                                  • Slide 74
                                                                                                                                                                                                                                                                                  • Slide 75
                                                                                                                                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                  • Slide 84
                                                                                                                                                                                                                                                                                  • Slide 85
                                                                                                                                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                                                                                                                                  • Slide 89
                                                                                                                                                                                                                                                                                  • Slide 90
                                                                                                                                                                                                                                                                                  • Slide 91
                                                                                                                                                                                                                                                                                  • Slide 92
                                                                                                                                                                                                                                                                                  • Slide 93
                                                                                                                                                                                                                                                                                  • Slide 94
                                                                                                                                                                                                                                                                                  • Slide 95
                                                                                                                                                                                                                                                                                  • Slide 96
                                                                                                                                                                                                                                                                                  • Slide 97
                                                                                                                                                                                                                                                                                  • Slide 98
                                                                                                                                                                                                                                                                                  • Slide 99
                                                                                                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                                                                                                  • Slide 101
                                                                                                                                                                                                                                                                                  • Slide 102
                                                                                                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                                                                                                  • Slide 106
                                                                                                                                                                                                                                                                                  • Slide 107
                                                                                                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                                                                                                  • Slide 109
                                                                                                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                                                                                                  • Time Out
                                                                                                                                                                                                                                                                                  • Token economy
                                                                                                                                                                                                                                                                                  • Slide 113
                                                                                                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                                                                                                  • Slide 115
                                                                                                                                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                                                                                                                                  • Slide 117
                                                                                                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                                                                                                  • Metacognition
                                                                                                                                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                  • Slide 124
                                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                  • Slide 128
                                                                                                                                                                                                                                                                                  • Slide 129
                                                                                                                                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                  • Slide 141
                                                                                                                                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                  • Slide 146
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                  • Slide 149
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                  • Slide 152
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                  • Slide 154
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                  • Slide 157
                                                                                                                                                                                                                                                                                  • Slide 158
                                                                                                                                                                                                                                                                                  • Slide 159
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                  • Slide 162
                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                  • Slide 164
                                                                                                                                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                  • Slide 166
                                                                                                                                                                                                                                                                                  • Slide 167
                                                                                                                                                                                                                                                                                  • Slide 168
                                                                                                                                                                                                                                                                                  • Slide 169
                                                                                                                                                                                                                                                                                  • Slide 170
                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                  • Match the Picture
                                                                                                                                                                                                                                                                                  • Slide 176
                                                                                                                                                                                                                                                                                  • Slide 177
                                                                                                                                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                                                                                                                                  • Slide 179
                                                                                                                                                                                                                                                                                  • Slide 180
                                                                                                                                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                                                                                                                                  • Learning Time
                                                                                                                                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                                                                                                                                  • Slide 185
                                                                                                                                                                                                                                                                                  • Slide 186
                                                                                                                                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                                                                                                                                  • Slide 189
                                                                                                                                                                                                                                                                                  • Slide 190
                                                                                                                                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                  • Slide 194
                                                                                                                                                                                                                                                                                  • Slide 195
                                                                                                                                                                                                                                                                                  • Slide 196
                                                                                                                                                                                                                                                                                  • Slide 197
                                                                                                                                                                                                                                                                                  • Slide 198
                                                                                                                                                                                                                                                                                  • Slide 199
                                                                                                                                                                                                                                                                                  • Slide 200
                                                                                                                                                                                                                                                                                  • Slide 201
                                                                                                                                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                                                                                                                                  • The post-mortem
                                                                                                                                                                                                                                                                                  • Slide 204
                                                                                                                                                                                                                                                                                  • Slide 205
                                                                                                                                                                                                                                                                                  • Slide 206
                                                                                                                                                                                                                                                                                  • Slide 207
                                                                                                                                                                                                                                                                                  • Slide 208
                                                                                                                                                                                                                                                                                  • Slide 209
                                                                                                                                                                                                                                                                                  • Slide 210
                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                  • Slide 212
                                                                                                                                                                                                                                                                                  • Slide 213
                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                  • Slide 215
                                                                                                                                                                                                                                                                                  • Slide 216
                                                                                                                                                                                                                                                                                  • Slide 217
                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                  • A challengehellip
                                                                                                                                                                                                                                                                                  • Slide 222

                                                                                                                                                                                                                                                                                    Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human Brain

                                                                                                                                                                                                                                                                                    Volkow et al 2004

                                                                                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                                                                                    Increase salience

                                                                                                                                                                                                                                                                                    Quarterly QI review

                                                                                                                                                                                                                                                                                    The post-mortem

                                                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                    Yoga read

                                                                                                                                                                                                                                                                                    Staff meeting

                                                                                                                                                                                                                                                                                    Planningsession

                                                                                                                                                                                                                                                                                    Phone calls

                                                                                                                                                                                                                                                                                    billing

                                                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                    Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                    Learn French

                                                                                                                                                                                                                                                                                    Stop smoking

                                                                                                                                                                                                                                                                                    Be a better spouse

                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                                                                                                                                    DavidNowell

                                                                                                                                                                                                                                                                                    • Slide 1
                                                                                                                                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                                                                                                                                    • Slide 3
                                                                                                                                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                    • Slide 7
                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                    • Overview
                                                                                                                                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                    • Slide 17
                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                    • Slide 19
                                                                                                                                                                                                                                                                                    • Strategies
                                                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                                                                                                    • Slide 23
                                                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                    • Slide 25
                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                    • Slide 27
                                                                                                                                                                                                                                                                                    • Slide 28
                                                                                                                                                                                                                                                                                    • Slide 29
                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                    • Slide 35
                                                                                                                                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                                                                                                                                    • (C)APD
                                                                                                                                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                    • Self-assessment
                                                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                    • Slide 42
                                                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                    • Core symptoms
                                                                                                                                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                    • Slide 53
                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                    • Slide 63
                                                                                                                                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                                                                                                                                    • Slide 66
                                                                                                                                                                                                                                                                                    • Slide 67
                                                                                                                                                                                                                                                                                    • ADHD and women
                                                                                                                                                                                                                                                                                    • Slide 69
                                                                                                                                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                                                                                                                                    • Slide 74
                                                                                                                                                                                                                                                                                    • Slide 75
                                                                                                                                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                    • Slide 84
                                                                                                                                                                                                                                                                                    • Slide 85
                                                                                                                                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                                                                                                                                    • Slide 89
                                                                                                                                                                                                                                                                                    • Slide 90
                                                                                                                                                                                                                                                                                    • Slide 91
                                                                                                                                                                                                                                                                                    • Slide 92
                                                                                                                                                                                                                                                                                    • Slide 93
                                                                                                                                                                                                                                                                                    • Slide 94
                                                                                                                                                                                                                                                                                    • Slide 95
                                                                                                                                                                                                                                                                                    • Slide 96
                                                                                                                                                                                                                                                                                    • Slide 97
                                                                                                                                                                                                                                                                                    • Slide 98
                                                                                                                                                                                                                                                                                    • Slide 99
                                                                                                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                                                                                                    • Slide 101
                                                                                                                                                                                                                                                                                    • Slide 102
                                                                                                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                                                                                                    • Slide 106
                                                                                                                                                                                                                                                                                    • Slide 107
                                                                                                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                                                                                                    • Slide 109
                                                                                                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                                                                                                    • Time Out
                                                                                                                                                                                                                                                                                    • Token economy
                                                                                                                                                                                                                                                                                    • Slide 113
                                                                                                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                                                                                                    • Slide 115
                                                                                                                                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                                                                                                                                    • Slide 117
                                                                                                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                                                                                                    • Metacognition
                                                                                                                                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                    • Slide 124
                                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                    • Slide 128
                                                                                                                                                                                                                                                                                    • Slide 129
                                                                                                                                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                    • Slide 141
                                                                                                                                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                    • Slide 146
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                    • Slide 149
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                    • Slide 152
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                    • Slide 154
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                    • Slide 157
                                                                                                                                                                                                                                                                                    • Slide 158
                                                                                                                                                                                                                                                                                    • Slide 159
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                    • Slide 162
                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                    • Slide 164
                                                                                                                                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                    • Slide 166
                                                                                                                                                                                                                                                                                    • Slide 167
                                                                                                                                                                                                                                                                                    • Slide 168
                                                                                                                                                                                                                                                                                    • Slide 169
                                                                                                                                                                                                                                                                                    • Slide 170
                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                    • Match the Picture
                                                                                                                                                                                                                                                                                    • Slide 176
                                                                                                                                                                                                                                                                                    • Slide 177
                                                                                                                                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                                                                                                                                    • Slide 179
                                                                                                                                                                                                                                                                                    • Slide 180
                                                                                                                                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                                                                                                                                    • Learning Time
                                                                                                                                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                                                                                                                                    • Slide 185
                                                                                                                                                                                                                                                                                    • Slide 186
                                                                                                                                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                                                                                                                                    • Slide 189
                                                                                                                                                                                                                                                                                    • Slide 190
                                                                                                                                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                    • Slide 194
                                                                                                                                                                                                                                                                                    • Slide 195
                                                                                                                                                                                                                                                                                    • Slide 196
                                                                                                                                                                                                                                                                                    • Slide 197
                                                                                                                                                                                                                                                                                    • Slide 198
                                                                                                                                                                                                                                                                                    • Slide 199
                                                                                                                                                                                                                                                                                    • Slide 200
                                                                                                                                                                                                                                                                                    • Slide 201
                                                                                                                                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                                                                                                                                    • The post-mortem
                                                                                                                                                                                                                                                                                    • Slide 204
                                                                                                                                                                                                                                                                                    • Slide 205
                                                                                                                                                                                                                                                                                    • Slide 206
                                                                                                                                                                                                                                                                                    • Slide 207
                                                                                                                                                                                                                                                                                    • Slide 208
                                                                                                                                                                                                                                                                                    • Slide 209
                                                                                                                                                                                                                                                                                    • Slide 210
                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                    • Slide 212
                                                                                                                                                                                                                                                                                    • Slide 213
                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                    • Slide 215
                                                                                                                                                                                                                                                                                    • Slide 216
                                                                                                                                                                                                                                                                                    • Slide 217
                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                    • A challengehellip
                                                                                                                                                                                                                                                                                    • Slide 222

                                                                                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                                                                                      Increase salience

                                                                                                                                                                                                                                                                                      Quarterly QI review

                                                                                                                                                                                                                                                                                      The post-mortem

                                                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                      Yoga read

                                                                                                                                                                                                                                                                                      Staff meeting

                                                                                                                                                                                                                                                                                      Planningsession

                                                                                                                                                                                                                                                                                      Phone calls

                                                                                                                                                                                                                                                                                      billing

                                                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                      Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                      Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                      Learn French

                                                                                                                                                                                                                                                                                      Stop smoking

                                                                                                                                                                                                                                                                                      Be a better spouse

                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                                                                                                                                                      DavidNowell

                                                                                                                                                                                                                                                                                      • Slide 1
                                                                                                                                                                                                                                                                                      • hellipa challenge
                                                                                                                                                                                                                                                                                      • Slide 3
                                                                                                                                                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                      • Slide 7
                                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                      • Overview
                                                                                                                                                                                                                                                                                      • This Dense Pudding
                                                                                                                                                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                                                                                                                      • Developmental considerations
                                                                                                                                                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                      • Slide 17
                                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                      • Slide 19
                                                                                                                                                                                                                                                                                      • Strategies
                                                                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                                                                                                                      • Slide 23
                                                                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                      • Slide 25
                                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                      • Slide 27
                                                                                                                                                                                                                                                                                      • Slide 28
                                                                                                                                                                                                                                                                                      • Slide 29
                                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                      • Slide 35
                                                                                                                                                                                                                                                                                      • Strategies (2)
                                                                                                                                                                                                                                                                                      • (C)APD
                                                                                                                                                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                      • Self-assessment
                                                                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                      • Slide 42
                                                                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                      • Core symptoms
                                                                                                                                                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                      • Slide 53
                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                      • Slide 63
                                                                                                                                                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                      • ADHD and girls
                                                                                                                                                                                                                                                                                      • Slide 66
                                                                                                                                                                                                                                                                                      • Slide 67
                                                                                                                                                                                                                                                                                      • ADHD and women
                                                                                                                                                                                                                                                                                      • Slide 69
                                                                                                                                                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                      • The Executive Functions
                                                                                                                                                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                                                                                                                                                      • Slide 74
                                                                                                                                                                                                                                                                                      • Slide 75
                                                                                                                                                                                                                                                                                      • Appropriate expectations
                                                                                                                                                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                      • Slide 84
                                                                                                                                                                                                                                                                                      • Slide 85
                                                                                                                                                                                                                                                                                      • Strategies (3)
                                                                                                                                                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                                                                                                                                                      • Behavioral Supports
                                                                                                                                                                                                                                                                                      • Slide 89
                                                                                                                                                                                                                                                                                      • Slide 90
                                                                                                                                                                                                                                                                                      • Slide 91
                                                                                                                                                                                                                                                                                      • Slide 92
                                                                                                                                                                                                                                                                                      • Slide 93
                                                                                                                                                                                                                                                                                      • Slide 94
                                                                                                                                                                                                                                                                                      • Slide 95
                                                                                                                                                                                                                                                                                      • Slide 96
                                                                                                                                                                                                                                                                                      • Slide 97
                                                                                                                                                                                                                                                                                      • Slide 98
                                                                                                                                                                                                                                                                                      • Slide 99
                                                                                                                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                                                                                                                      • Slide 101
                                                                                                                                                                                                                                                                                      • Slide 102
                                                                                                                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                                                                                                                      • Slide 106
                                                                                                                                                                                                                                                                                      • Slide 107
                                                                                                                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                                                                                                                      • Slide 109
                                                                                                                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                                                                                                                      • Time Out
                                                                                                                                                                                                                                                                                      • Token economy
                                                                                                                                                                                                                                                                                      • Slide 113
                                                                                                                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                                                                                                                      • Slide 115
                                                                                                                                                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                                                                                                                                                      • Slide 117
                                                                                                                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                                                                                                                      • Metacognition
                                                                                                                                                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                      • Slide 124
                                                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                      • Slide 128
                                                                                                                                                                                                                                                                                      • Slide 129
                                                                                                                                                                                                                                                                                      • Broaden and Build
                                                                                                                                                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                      • Slide 141
                                                                                                                                                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                      • Slide 146
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                      • Slide 149
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                      • Slide 152
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                      • Slide 154
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                      • Slide 157
                                                                                                                                                                                                                                                                                      • Slide 158
                                                                                                                                                                                                                                                                                      • Slide 159
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                      • Slide 162
                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                      • Slide 164
                                                                                                                                                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                      • Slide 166
                                                                                                                                                                                                                                                                                      • Slide 167
                                                                                                                                                                                                                                                                                      • Slide 168
                                                                                                                                                                                                                                                                                      • Slide 169
                                                                                                                                                                                                                                                                                      • Slide 170
                                                                                                                                                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                      • Match the Picture
                                                                                                                                                                                                                                                                                      • Slide 176
                                                                                                                                                                                                                                                                                      • Slide 177
                                                                                                                                                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                                                                                                                                                      • Slide 179
                                                                                                                                                                                                                                                                                      • Slide 180
                                                                                                                                                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                                                                                                                                                      • Learning Time
                                                                                                                                                                                                                                                                                      • Learning Time (2)
                                                                                                                                                                                                                                                                                      • Learning Time (3)
                                                                                                                                                                                                                                                                                      • Slide 185
                                                                                                                                                                                                                                                                                      • Slide 186
                                                                                                                                                                                                                                                                                      • Learning Time (4)
                                                                                                                                                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                                                                                                                                                      • Slide 189
                                                                                                                                                                                                                                                                                      • Slide 190
                                                                                                                                                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                      • Slide 194
                                                                                                                                                                                                                                                                                      • Slide 195
                                                                                                                                                                                                                                                                                      • Slide 196
                                                                                                                                                                                                                                                                                      • Slide 197
                                                                                                                                                                                                                                                                                      • Slide 198
                                                                                                                                                                                                                                                                                      • Slide 199
                                                                                                                                                                                                                                                                                      • Slide 200
                                                                                                                                                                                                                                                                                      • Slide 201
                                                                                                                                                                                                                                                                                      • Quarterly QI review
                                                                                                                                                                                                                                                                                      • The post-mortem
                                                                                                                                                                                                                                                                                      • Slide 204
                                                                                                                                                                                                                                                                                      • Slide 205
                                                                                                                                                                                                                                                                                      • Slide 206
                                                                                                                                                                                                                                                                                      • Slide 207
                                                                                                                                                                                                                                                                                      • Slide 208
                                                                                                                                                                                                                                                                                      • Slide 209
                                                                                                                                                                                                                                                                                      • Slide 210
                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                      • Slide 212
                                                                                                                                                                                                                                                                                      • Slide 213
                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                      • Slide 215
                                                                                                                                                                                                                                                                                      • Slide 216
                                                                                                                                                                                                                                                                                      • Slide 217
                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                      • A challengehellip
                                                                                                                                                                                                                                                                                      • Slide 222

                                                                                                                                                                                                                                                                                        Increase salience

                                                                                                                                                                                                                                                                                        Quarterly QI review

                                                                                                                                                                                                                                                                                        The post-mortem

                                                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                        Yoga read

                                                                                                                                                                                                                                                                                        Staff meeting

                                                                                                                                                                                                                                                                                        Planningsession

                                                                                                                                                                                                                                                                                        Phone calls

                                                                                                                                                                                                                                                                                        billing

                                                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                        Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                        Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                        Learn French

                                                                                                                                                                                                                                                                                        Stop smoking

                                                                                                                                                                                                                                                                                        Be a better spouse

                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                                                                                                                                                        DavidNowell

                                                                                                                                                                                                                                                                                        • Slide 1
                                                                                                                                                                                                                                                                                        • hellipa challenge
                                                                                                                                                                                                                                                                                        • Slide 3
                                                                                                                                                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                        • Slide 7
                                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                        • Overview
                                                                                                                                                                                                                                                                                        • This Dense Pudding
                                                                                                                                                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                                                                                                                        • Developmental considerations
                                                                                                                                                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                        • Slide 17
                                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                        • Slide 19
                                                                                                                                                                                                                                                                                        • Strategies
                                                                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                                                                                                                        • Slide 23
                                                                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                        • Slide 25
                                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                        • Slide 27
                                                                                                                                                                                                                                                                                        • Slide 28
                                                                                                                                                                                                                                                                                        • Slide 29
                                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                        • Slide 35
                                                                                                                                                                                                                                                                                        • Strategies (2)
                                                                                                                                                                                                                                                                                        • (C)APD
                                                                                                                                                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                        • Self-assessment
                                                                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                        • Slide 42
                                                                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                        • Core symptoms
                                                                                                                                                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                        • Slide 53
                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                        • Slide 63
                                                                                                                                                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                        • ADHD and girls
                                                                                                                                                                                                                                                                                        • Slide 66
                                                                                                                                                                                                                                                                                        • Slide 67
                                                                                                                                                                                                                                                                                        • ADHD and women
                                                                                                                                                                                                                                                                                        • Slide 69
                                                                                                                                                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                        • The Executive Functions
                                                                                                                                                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                                                                                                                                                        • Slide 74
                                                                                                                                                                                                                                                                                        • Slide 75
                                                                                                                                                                                                                                                                                        • Appropriate expectations
                                                                                                                                                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                        • Slide 84
                                                                                                                                                                                                                                                                                        • Slide 85
                                                                                                                                                                                                                                                                                        • Strategies (3)
                                                                                                                                                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                                                                                                                                                        • Behavioral Supports
                                                                                                                                                                                                                                                                                        • Slide 89
                                                                                                                                                                                                                                                                                        • Slide 90
                                                                                                                                                                                                                                                                                        • Slide 91
                                                                                                                                                                                                                                                                                        • Slide 92
                                                                                                                                                                                                                                                                                        • Slide 93
                                                                                                                                                                                                                                                                                        • Slide 94
                                                                                                                                                                                                                                                                                        • Slide 95
                                                                                                                                                                                                                                                                                        • Slide 96
                                                                                                                                                                                                                                                                                        • Slide 97
                                                                                                                                                                                                                                                                                        • Slide 98
                                                                                                                                                                                                                                                                                        • Slide 99
                                                                                                                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                                                                                                                        • Slide 101
                                                                                                                                                                                                                                                                                        • Slide 102
                                                                                                                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                                                                                                                        • Slide 106
                                                                                                                                                                                                                                                                                        • Slide 107
                                                                                                                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                                                                                                                        • Slide 109
                                                                                                                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                                                                                                                        • Time Out
                                                                                                                                                                                                                                                                                        • Token economy
                                                                                                                                                                                                                                                                                        • Slide 113
                                                                                                                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                                                                                                                        • Slide 115
                                                                                                                                                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                                                                                                                                                        • Slide 117
                                                                                                                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                                                                                                                        • Metacognition
                                                                                                                                                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                        • Slide 124
                                                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                        • Slide 128
                                                                                                                                                                                                                                                                                        • Slide 129
                                                                                                                                                                                                                                                                                        • Broaden and Build
                                                                                                                                                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                        • Slide 141
                                                                                                                                                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                        • Slide 146
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                        • Slide 149
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                        • Slide 152
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                        • Slide 154
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                        • Slide 157
                                                                                                                                                                                                                                                                                        • Slide 158
                                                                                                                                                                                                                                                                                        • Slide 159
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                        • Slide 162
                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                        • Slide 164
                                                                                                                                                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                        • Slide 166
                                                                                                                                                                                                                                                                                        • Slide 167
                                                                                                                                                                                                                                                                                        • Slide 168
                                                                                                                                                                                                                                                                                        • Slide 169
                                                                                                                                                                                                                                                                                        • Slide 170
                                                                                                                                                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                        • Match the Picture
                                                                                                                                                                                                                                                                                        • Slide 176
                                                                                                                                                                                                                                                                                        • Slide 177
                                                                                                                                                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                                                                                                                                                        • Slide 179
                                                                                                                                                                                                                                                                                        • Slide 180
                                                                                                                                                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                                                                                                                                                        • Learning Time
                                                                                                                                                                                                                                                                                        • Learning Time (2)
                                                                                                                                                                                                                                                                                        • Learning Time (3)
                                                                                                                                                                                                                                                                                        • Slide 185
                                                                                                                                                                                                                                                                                        • Slide 186
                                                                                                                                                                                                                                                                                        • Learning Time (4)
                                                                                                                                                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                                                                                                                                                        • Slide 189
                                                                                                                                                                                                                                                                                        • Slide 190
                                                                                                                                                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                        • Slide 194
                                                                                                                                                                                                                                                                                        • Slide 195
                                                                                                                                                                                                                                                                                        • Slide 196
                                                                                                                                                                                                                                                                                        • Slide 197
                                                                                                                                                                                                                                                                                        • Slide 198
                                                                                                                                                                                                                                                                                        • Slide 199
                                                                                                                                                                                                                                                                                        • Slide 200
                                                                                                                                                                                                                                                                                        • Slide 201
                                                                                                                                                                                                                                                                                        • Quarterly QI review
                                                                                                                                                                                                                                                                                        • The post-mortem
                                                                                                                                                                                                                                                                                        • Slide 204
                                                                                                                                                                                                                                                                                        • Slide 205
                                                                                                                                                                                                                                                                                        • Slide 206
                                                                                                                                                                                                                                                                                        • Slide 207
                                                                                                                                                                                                                                                                                        • Slide 208
                                                                                                                                                                                                                                                                                        • Slide 209
                                                                                                                                                                                                                                                                                        • Slide 210
                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                        • Slide 212
                                                                                                                                                                                                                                                                                        • Slide 213
                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                        • Slide 215
                                                                                                                                                                                                                                                                                        • Slide 216
                                                                                                                                                                                                                                                                                        • Slide 217
                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                        • A challengehellip
                                                                                                                                                                                                                                                                                        • Slide 222

                                                                                                                                                                                                                                                                                          Quarterly QI review

                                                                                                                                                                                                                                                                                          The post-mortem

                                                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                          Yoga read

                                                                                                                                                                                                                                                                                          Staff meeting

                                                                                                                                                                                                                                                                                          Planningsession

                                                                                                                                                                                                                                                                                          Phone calls

                                                                                                                                                                                                                                                                                          billing

                                                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                          Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                          Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                          Learn French

                                                                                                                                                                                                                                                                                          Stop smoking

                                                                                                                                                                                                                                                                                          Be a better spouse

                                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                                                                                                                                                          DavidNowell

                                                                                                                                                                                                                                                                                          • Slide 1
                                                                                                                                                                                                                                                                                          • hellipa challenge
                                                                                                                                                                                                                                                                                          • Slide 3
                                                                                                                                                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                          • Slide 7
                                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                          • Overview
                                                                                                                                                                                                                                                                                          • This Dense Pudding
                                                                                                                                                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                                                                                                                          • Developmental considerations
                                                                                                                                                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                          • Slide 17
                                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                          • Slide 19
                                                                                                                                                                                                                                                                                          • Strategies
                                                                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                                                                                                                          • Slide 23
                                                                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                          • Slide 25
                                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                          • Slide 27
                                                                                                                                                                                                                                                                                          • Slide 28
                                                                                                                                                                                                                                                                                          • Slide 29
                                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                          • Slide 35
                                                                                                                                                                                                                                                                                          • Strategies (2)
                                                                                                                                                                                                                                                                                          • (C)APD
                                                                                                                                                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                          • Self-assessment
                                                                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                          • Slide 42
                                                                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                          • Core symptoms
                                                                                                                                                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                          • Slide 53
                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                          • Slide 63
                                                                                                                                                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                          • ADHD and girls
                                                                                                                                                                                                                                                                                          • Slide 66
                                                                                                                                                                                                                                                                                          • Slide 67
                                                                                                                                                                                                                                                                                          • ADHD and women
                                                                                                                                                                                                                                                                                          • Slide 69
                                                                                                                                                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                          • The Executive Functions
                                                                                                                                                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                                                                                                                                                          • Slide 74
                                                                                                                                                                                                                                                                                          • Slide 75
                                                                                                                                                                                                                                                                                          • Appropriate expectations
                                                                                                                                                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                          • Slide 84
                                                                                                                                                                                                                                                                                          • Slide 85
                                                                                                                                                                                                                                                                                          • Strategies (3)
                                                                                                                                                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                                                                                                                                                          • Behavioral Supports
                                                                                                                                                                                                                                                                                          • Slide 89
                                                                                                                                                                                                                                                                                          • Slide 90
                                                                                                                                                                                                                                                                                          • Slide 91
                                                                                                                                                                                                                                                                                          • Slide 92
                                                                                                                                                                                                                                                                                          • Slide 93
                                                                                                                                                                                                                                                                                          • Slide 94
                                                                                                                                                                                                                                                                                          • Slide 95
                                                                                                                                                                                                                                                                                          • Slide 96
                                                                                                                                                                                                                                                                                          • Slide 97
                                                                                                                                                                                                                                                                                          • Slide 98
                                                                                                                                                                                                                                                                                          • Slide 99
                                                                                                                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                                                                                                                          • Slide 101
                                                                                                                                                                                                                                                                                          • Slide 102
                                                                                                                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                                                                                                                          • Slide 106
                                                                                                                                                                                                                                                                                          • Slide 107
                                                                                                                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                                                                                                                          • Slide 109
                                                                                                                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                                                                                                                          • Time Out
                                                                                                                                                                                                                                                                                          • Token economy
                                                                                                                                                                                                                                                                                          • Slide 113
                                                                                                                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                                                                                                                          • Slide 115
                                                                                                                                                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                                                                                                                                                          • Slide 117
                                                                                                                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                                                                                                                          • Metacognition
                                                                                                                                                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                          • Slide 124
                                                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                          • Slide 128
                                                                                                                                                                                                                                                                                          • Slide 129
                                                                                                                                                                                                                                                                                          • Broaden and Build
                                                                                                                                                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                          • Slide 141
                                                                                                                                                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                          • Slide 146
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                          • Slide 149
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                          • Slide 152
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                          • Slide 154
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                          • Slide 157
                                                                                                                                                                                                                                                                                          • Slide 158
                                                                                                                                                                                                                                                                                          • Slide 159
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                          • Slide 162
                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                          • Slide 164
                                                                                                                                                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                          • Slide 166
                                                                                                                                                                                                                                                                                          • Slide 167
                                                                                                                                                                                                                                                                                          • Slide 168
                                                                                                                                                                                                                                                                                          • Slide 169
                                                                                                                                                                                                                                                                                          • Slide 170
                                                                                                                                                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                          • Match the Picture
                                                                                                                                                                                                                                                                                          • Slide 176
                                                                                                                                                                                                                                                                                          • Slide 177
                                                                                                                                                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                                                                                                                                                          • Slide 179
                                                                                                                                                                                                                                                                                          • Slide 180
                                                                                                                                                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                                                                                                                                                          • Learning Time
                                                                                                                                                                                                                                                                                          • Learning Time (2)
                                                                                                                                                                                                                                                                                          • Learning Time (3)
                                                                                                                                                                                                                                                                                          • Slide 185
                                                                                                                                                                                                                                                                                          • Slide 186
                                                                                                                                                                                                                                                                                          • Learning Time (4)
                                                                                                                                                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                                                                                                                                                          • Slide 189
                                                                                                                                                                                                                                                                                          • Slide 190
                                                                                                                                                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                          • Slide 194
                                                                                                                                                                                                                                                                                          • Slide 195
                                                                                                                                                                                                                                                                                          • Slide 196
                                                                                                                                                                                                                                                                                          • Slide 197
                                                                                                                                                                                                                                                                                          • Slide 198
                                                                                                                                                                                                                                                                                          • Slide 199
                                                                                                                                                                                                                                                                                          • Slide 200
                                                                                                                                                                                                                                                                                          • Slide 201
                                                                                                                                                                                                                                                                                          • Quarterly QI review
                                                                                                                                                                                                                                                                                          • The post-mortem
                                                                                                                                                                                                                                                                                          • Slide 204
                                                                                                                                                                                                                                                                                          • Slide 205
                                                                                                                                                                                                                                                                                          • Slide 206
                                                                                                                                                                                                                                                                                          • Slide 207
                                                                                                                                                                                                                                                                                          • Slide 208
                                                                                                                                                                                                                                                                                          • Slide 209
                                                                                                                                                                                                                                                                                          • Slide 210
                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                          • Slide 212
                                                                                                                                                                                                                                                                                          • Slide 213
                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                          • Slide 215
                                                                                                                                                                                                                                                                                          • Slide 216
                                                                                                                                                                                                                                                                                          • Slide 217
                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                          • A challengehellip
                                                                                                                                                                                                                                                                                          • Slide 222

                                                                                                                                                                                                                                                                                            The post-mortem

                                                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                            Yoga read

                                                                                                                                                                                                                                                                                            Staff meeting

                                                                                                                                                                                                                                                                                            Planningsession

                                                                                                                                                                                                                                                                                            Phone calls

                                                                                                                                                                                                                                                                                            billing

                                                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                            Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                            Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                            Learn French

                                                                                                                                                                                                                                                                                            Stop smoking

                                                                                                                                                                                                                                                                                            Be a better spouse

                                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                                                                                                                                                            DavidNowell

                                                                                                                                                                                                                                                                                            • Slide 1
                                                                                                                                                                                                                                                                                            • hellipa challenge
                                                                                                                                                                                                                                                                                            • Slide 3
                                                                                                                                                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                            • Slide 7
                                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                            • Overview
                                                                                                                                                                                                                                                                                            • This Dense Pudding
                                                                                                                                                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                                                                                                                            • Developmental considerations
                                                                                                                                                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                            • Slide 17
                                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                            • Slide 19
                                                                                                                                                                                                                                                                                            • Strategies
                                                                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                                                                                                                            • Slide 23
                                                                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                            • Slide 25
                                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                            • Slide 27
                                                                                                                                                                                                                                                                                            • Slide 28
                                                                                                                                                                                                                                                                                            • Slide 29
                                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                            • Slide 35
                                                                                                                                                                                                                                                                                            • Strategies (2)
                                                                                                                                                                                                                                                                                            • (C)APD
                                                                                                                                                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                            • Self-assessment
                                                                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                            • Slide 42
                                                                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                            • Core symptoms
                                                                                                                                                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                            • Slide 53
                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                            • Slide 63
                                                                                                                                                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                            • ADHD and girls
                                                                                                                                                                                                                                                                                            • Slide 66
                                                                                                                                                                                                                                                                                            • Slide 67
                                                                                                                                                                                                                                                                                            • ADHD and women
                                                                                                                                                                                                                                                                                            • Slide 69
                                                                                                                                                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                            • The Executive Functions
                                                                                                                                                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                                                                                                                                                            • Slide 74
                                                                                                                                                                                                                                                                                            • Slide 75
                                                                                                                                                                                                                                                                                            • Appropriate expectations
                                                                                                                                                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                            • Slide 84
                                                                                                                                                                                                                                                                                            • Slide 85
                                                                                                                                                                                                                                                                                            • Strategies (3)
                                                                                                                                                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                                                                                                                                                            • Behavioral Supports
                                                                                                                                                                                                                                                                                            • Slide 89
                                                                                                                                                                                                                                                                                            • Slide 90
                                                                                                                                                                                                                                                                                            • Slide 91
                                                                                                                                                                                                                                                                                            • Slide 92
                                                                                                                                                                                                                                                                                            • Slide 93
                                                                                                                                                                                                                                                                                            • Slide 94
                                                                                                                                                                                                                                                                                            • Slide 95
                                                                                                                                                                                                                                                                                            • Slide 96
                                                                                                                                                                                                                                                                                            • Slide 97
                                                                                                                                                                                                                                                                                            • Slide 98
                                                                                                                                                                                                                                                                                            • Slide 99
                                                                                                                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                                                                                                                            • Slide 101
                                                                                                                                                                                                                                                                                            • Slide 102
                                                                                                                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                                                                                                                            • Slide 106
                                                                                                                                                                                                                                                                                            • Slide 107
                                                                                                                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                                                                                                                            • Slide 109
                                                                                                                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                                                                                                                            • Time Out
                                                                                                                                                                                                                                                                                            • Token economy
                                                                                                                                                                                                                                                                                            • Slide 113
                                                                                                                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                                                                                                                            • Slide 115
                                                                                                                                                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                                                                                                                                                            • Slide 117
                                                                                                                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                                                                                                                            • Metacognition
                                                                                                                                                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                            • Slide 124
                                                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                            • Slide 128
                                                                                                                                                                                                                                                                                            • Slide 129
                                                                                                                                                                                                                                                                                            • Broaden and Build
                                                                                                                                                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                            • Slide 141
                                                                                                                                                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                            • Slide 146
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                            • Slide 149
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                            • Slide 152
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                            • Slide 154
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                            • Slide 157
                                                                                                                                                                                                                                                                                            • Slide 158
                                                                                                                                                                                                                                                                                            • Slide 159
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                            • Slide 162
                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                            • Slide 164
                                                                                                                                                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                            • Slide 166
                                                                                                                                                                                                                                                                                            • Slide 167
                                                                                                                                                                                                                                                                                            • Slide 168
                                                                                                                                                                                                                                                                                            • Slide 169
                                                                                                                                                                                                                                                                                            • Slide 170
                                                                                                                                                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                            • Match the Picture
                                                                                                                                                                                                                                                                                            • Slide 176
                                                                                                                                                                                                                                                                                            • Slide 177
                                                                                                                                                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                                                                                                                                                            • Slide 179
                                                                                                                                                                                                                                                                                            • Slide 180
                                                                                                                                                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                                                                                                                                                            • Learning Time
                                                                                                                                                                                                                                                                                            • Learning Time (2)
                                                                                                                                                                                                                                                                                            • Learning Time (3)
                                                                                                                                                                                                                                                                                            • Slide 185
                                                                                                                                                                                                                                                                                            • Slide 186
                                                                                                                                                                                                                                                                                            • Learning Time (4)
                                                                                                                                                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                                                                                                                                                            • Slide 189
                                                                                                                                                                                                                                                                                            • Slide 190
                                                                                                                                                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                            • Slide 194
                                                                                                                                                                                                                                                                                            • Slide 195
                                                                                                                                                                                                                                                                                            • Slide 196
                                                                                                                                                                                                                                                                                            • Slide 197
                                                                                                                                                                                                                                                                                            • Slide 198
                                                                                                                                                                                                                                                                                            • Slide 199
                                                                                                                                                                                                                                                                                            • Slide 200
                                                                                                                                                                                                                                                                                            • Slide 201
                                                                                                                                                                                                                                                                                            • Quarterly QI review
                                                                                                                                                                                                                                                                                            • The post-mortem
                                                                                                                                                                                                                                                                                            • Slide 204
                                                                                                                                                                                                                                                                                            • Slide 205
                                                                                                                                                                                                                                                                                            • Slide 206
                                                                                                                                                                                                                                                                                            • Slide 207
                                                                                                                                                                                                                                                                                            • Slide 208
                                                                                                                                                                                                                                                                                            • Slide 209
                                                                                                                                                                                                                                                                                            • Slide 210
                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                            • Slide 212
                                                                                                                                                                                                                                                                                            • Slide 213
                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                            • Slide 215
                                                                                                                                                                                                                                                                                            • Slide 216
                                                                                                                                                                                                                                                                                            • Slide 217
                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                            • A challengehellip
                                                                                                                                                                                                                                                                                            • Slide 222

                                                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                              Yoga read

                                                                                                                                                                                                                                                                                              Staff meeting

                                                                                                                                                                                                                                                                                              Planningsession

                                                                                                                                                                                                                                                                                              Phone calls

                                                                                                                                                                                                                                                                                              billing

                                                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                              Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                              Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                              Learn French

                                                                                                                                                                                                                                                                                              Stop smoking

                                                                                                                                                                                                                                                                                              Be a better spouse

                                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                                                                                                                                                              DavidNowell

                                                                                                                                                                                                                                                                                              • Slide 1
                                                                                                                                                                                                                                                                                              • hellipa challenge
                                                                                                                                                                                                                                                                                              • Slide 3
                                                                                                                                                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                              • Slide 7
                                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                              • Overview
                                                                                                                                                                                                                                                                                              • This Dense Pudding
                                                                                                                                                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                                                                                                                              • Developmental considerations
                                                                                                                                                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                              • Slide 17
                                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                              • Slide 19
                                                                                                                                                                                                                                                                                              • Strategies
                                                                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                                                                                                                              • Slide 23
                                                                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                              • Slide 25
                                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                              • Slide 27
                                                                                                                                                                                                                                                                                              • Slide 28
                                                                                                                                                                                                                                                                                              • Slide 29
                                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                              • Slide 35
                                                                                                                                                                                                                                                                                              • Strategies (2)
                                                                                                                                                                                                                                                                                              • (C)APD
                                                                                                                                                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                              • Self-assessment
                                                                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                              • Slide 42
                                                                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                              • Core symptoms
                                                                                                                                                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                              • Slide 53
                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                              • Slide 63
                                                                                                                                                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                              • ADHD and girls
                                                                                                                                                                                                                                                                                              • Slide 66
                                                                                                                                                                                                                                                                                              • Slide 67
                                                                                                                                                                                                                                                                                              • ADHD and women
                                                                                                                                                                                                                                                                                              • Slide 69
                                                                                                                                                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                              • The Executive Functions
                                                                                                                                                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                                                                                                                                                              • Slide 74
                                                                                                                                                                                                                                                                                              • Slide 75
                                                                                                                                                                                                                                                                                              • Appropriate expectations
                                                                                                                                                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                              • Slide 84
                                                                                                                                                                                                                                                                                              • Slide 85
                                                                                                                                                                                                                                                                                              • Strategies (3)
                                                                                                                                                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                                                                                                                                                              • Behavioral Supports
                                                                                                                                                                                                                                                                                              • Slide 89
                                                                                                                                                                                                                                                                                              • Slide 90
                                                                                                                                                                                                                                                                                              • Slide 91
                                                                                                                                                                                                                                                                                              • Slide 92
                                                                                                                                                                                                                                                                                              • Slide 93
                                                                                                                                                                                                                                                                                              • Slide 94
                                                                                                                                                                                                                                                                                              • Slide 95
                                                                                                                                                                                                                                                                                              • Slide 96
                                                                                                                                                                                                                                                                                              • Slide 97
                                                                                                                                                                                                                                                                                              • Slide 98
                                                                                                                                                                                                                                                                                              • Slide 99
                                                                                                                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                                                                                                                              • Slide 101
                                                                                                                                                                                                                                                                                              • Slide 102
                                                                                                                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                                                                                                                              • Slide 106
                                                                                                                                                                                                                                                                                              • Slide 107
                                                                                                                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                                                                                                                              • Slide 109
                                                                                                                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                                                                                                                              • Time Out
                                                                                                                                                                                                                                                                                              • Token economy
                                                                                                                                                                                                                                                                                              • Slide 113
                                                                                                                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                                                                                                                              • Slide 115
                                                                                                                                                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                                                                                                                                                              • Slide 117
                                                                                                                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                                                                                                                              • Metacognition
                                                                                                                                                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                              • Slide 124
                                                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                              • Slide 128
                                                                                                                                                                                                                                                                                              • Slide 129
                                                                                                                                                                                                                                                                                              • Broaden and Build
                                                                                                                                                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                              • Slide 141
                                                                                                                                                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                              • Slide 146
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                              • Slide 149
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                              • Slide 152
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                              • Slide 154
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                              • Slide 157
                                                                                                                                                                                                                                                                                              • Slide 158
                                                                                                                                                                                                                                                                                              • Slide 159
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                              • Slide 162
                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                              • Slide 164
                                                                                                                                                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                              • Slide 166
                                                                                                                                                                                                                                                                                              • Slide 167
                                                                                                                                                                                                                                                                                              • Slide 168
                                                                                                                                                                                                                                                                                              • Slide 169
                                                                                                                                                                                                                                                                                              • Slide 170
                                                                                                                                                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                              • Match the Picture
                                                                                                                                                                                                                                                                                              • Slide 176
                                                                                                                                                                                                                                                                                              • Slide 177
                                                                                                                                                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                                                                                                                                                              • Slide 179
                                                                                                                                                                                                                                                                                              • Slide 180
                                                                                                                                                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                                                                                                                                                              • Learning Time
                                                                                                                                                                                                                                                                                              • Learning Time (2)
                                                                                                                                                                                                                                                                                              • Learning Time (3)
                                                                                                                                                                                                                                                                                              • Slide 185
                                                                                                                                                                                                                                                                                              • Slide 186
                                                                                                                                                                                                                                                                                              • Learning Time (4)
                                                                                                                                                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                                                                                                                                                              • Slide 189
                                                                                                                                                                                                                                                                                              • Slide 190
                                                                                                                                                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                              • Slide 194
                                                                                                                                                                                                                                                                                              • Slide 195
                                                                                                                                                                                                                                                                                              • Slide 196
                                                                                                                                                                                                                                                                                              • Slide 197
                                                                                                                                                                                                                                                                                              • Slide 198
                                                                                                                                                                                                                                                                                              • Slide 199
                                                                                                                                                                                                                                                                                              • Slide 200
                                                                                                                                                                                                                                                                                              • Slide 201
                                                                                                                                                                                                                                                                                              • Quarterly QI review
                                                                                                                                                                                                                                                                                              • The post-mortem
                                                                                                                                                                                                                                                                                              • Slide 204
                                                                                                                                                                                                                                                                                              • Slide 205
                                                                                                                                                                                                                                                                                              • Slide 206
                                                                                                                                                                                                                                                                                              • Slide 207
                                                                                                                                                                                                                                                                                              • Slide 208
                                                                                                                                                                                                                                                                                              • Slide 209
                                                                                                                                                                                                                                                                                              • Slide 210
                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                              • Slide 212
                                                                                                                                                                                                                                                                                              • Slide 213
                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                              • Slide 215
                                                                                                                                                                                                                                                                                              • Slide 216
                                                                                                                                                                                                                                                                                              • Slide 217
                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                              • A challengehellip
                                                                                                                                                                                                                                                                                              • Slide 222

                                                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                                Yoga read

                                                                                                                                                                                                                                                                                                Staff meeting

                                                                                                                                                                                                                                                                                                Planningsession

                                                                                                                                                                                                                                                                                                Phone calls

                                                                                                                                                                                                                                                                                                billing

                                                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                                Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                                Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                                Learn French

                                                                                                                                                                                                                                                                                                Stop smoking

                                                                                                                                                                                                                                                                                                Be a better spouse

                                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                                                                                                                                                DavidNowell

                                                                                                                                                                                                                                                                                                • Slide 1
                                                                                                                                                                                                                                                                                                • hellipa challenge
                                                                                                                                                                                                                                                                                                • Slide 3
                                                                                                                                                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                • Slide 7
                                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                • Overview
                                                                                                                                                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                                                                                                                • Developmental considerations
                                                                                                                                                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                • Slide 17
                                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                • Slide 19
                                                                                                                                                                                                                                                                                                • Strategies
                                                                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                                                                                                                • Slide 23
                                                                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                • Slide 25
                                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                • Slide 27
                                                                                                                                                                                                                                                                                                • Slide 28
                                                                                                                                                                                                                                                                                                • Slide 29
                                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                • Slide 35
                                                                                                                                                                                                                                                                                                • Strategies (2)
                                                                                                                                                                                                                                                                                                • (C)APD
                                                                                                                                                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                • Self-assessment
                                                                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                • Slide 42
                                                                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                • Core symptoms
                                                                                                                                                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                • Slide 53
                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                • Slide 63
                                                                                                                                                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                • ADHD and girls
                                                                                                                                                                                                                                                                                                • Slide 66
                                                                                                                                                                                                                                                                                                • Slide 67
                                                                                                                                                                                                                                                                                                • ADHD and women
                                                                                                                                                                                                                                                                                                • Slide 69
                                                                                                                                                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                • The Executive Functions
                                                                                                                                                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                • Slide 74
                                                                                                                                                                                                                                                                                                • Slide 75
                                                                                                                                                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                • Slide 84
                                                                                                                                                                                                                                                                                                • Slide 85
                                                                                                                                                                                                                                                                                                • Strategies (3)
                                                                                                                                                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                                                                                                                                                • Slide 89
                                                                                                                                                                                                                                                                                                • Slide 90
                                                                                                                                                                                                                                                                                                • Slide 91
                                                                                                                                                                                                                                                                                                • Slide 92
                                                                                                                                                                                                                                                                                                • Slide 93
                                                                                                                                                                                                                                                                                                • Slide 94
                                                                                                                                                                                                                                                                                                • Slide 95
                                                                                                                                                                                                                                                                                                • Slide 96
                                                                                                                                                                                                                                                                                                • Slide 97
                                                                                                                                                                                                                                                                                                • Slide 98
                                                                                                                                                                                                                                                                                                • Slide 99
                                                                                                                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                                                                                                                • Slide 101
                                                                                                                                                                                                                                                                                                • Slide 102
                                                                                                                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                                                                                                                • Slide 106
                                                                                                                                                                                                                                                                                                • Slide 107
                                                                                                                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                                                                                                                • Slide 109
                                                                                                                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                                                                                                                • Time Out
                                                                                                                                                                                                                                                                                                • Token economy
                                                                                                                                                                                                                                                                                                • Slide 113
                                                                                                                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                                                                                                                • Slide 115
                                                                                                                                                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                                                                                                                                                • Slide 117
                                                                                                                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                                                                                                                • Metacognition
                                                                                                                                                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                • Slide 124
                                                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                • Slide 128
                                                                                                                                                                                                                                                                                                • Slide 129
                                                                                                                                                                                                                                                                                                • Broaden and Build
                                                                                                                                                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                • Slide 141
                                                                                                                                                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                • Slide 146
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                • Slide 149
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                • Slide 152
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                • Slide 154
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                • Slide 157
                                                                                                                                                                                                                                                                                                • Slide 158
                                                                                                                                                                                                                                                                                                • Slide 159
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                • Slide 162
                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                • Slide 164
                                                                                                                                                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                • Slide 166
                                                                                                                                                                                                                                                                                                • Slide 167
                                                                                                                                                                                                                                                                                                • Slide 168
                                                                                                                                                                                                                                                                                                • Slide 169
                                                                                                                                                                                                                                                                                                • Slide 170
                                                                                                                                                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                • Match the Picture
                                                                                                                                                                                                                                                                                                • Slide 176
                                                                                                                                                                                                                                                                                                • Slide 177
                                                                                                                                                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                                                                                                                                                • Slide 179
                                                                                                                                                                                                                                                                                                • Slide 180
                                                                                                                                                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                                                                                                                                                • Learning Time
                                                                                                                                                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                                                                                                                                                • Slide 185
                                                                                                                                                                                                                                                                                                • Slide 186
                                                                                                                                                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                                                                                                                                                • Slide 189
                                                                                                                                                                                                                                                                                                • Slide 190
                                                                                                                                                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                • Slide 194
                                                                                                                                                                                                                                                                                                • Slide 195
                                                                                                                                                                                                                                                                                                • Slide 196
                                                                                                                                                                                                                                                                                                • Slide 197
                                                                                                                                                                                                                                                                                                • Slide 198
                                                                                                                                                                                                                                                                                                • Slide 199
                                                                                                                                                                                                                                                                                                • Slide 200
                                                                                                                                                                                                                                                                                                • Slide 201
                                                                                                                                                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                                                                                                                                                • The post-mortem
                                                                                                                                                                                                                                                                                                • Slide 204
                                                                                                                                                                                                                                                                                                • Slide 205
                                                                                                                                                                                                                                                                                                • Slide 206
                                                                                                                                                                                                                                                                                                • Slide 207
                                                                                                                                                                                                                                                                                                • Slide 208
                                                                                                                                                                                                                                                                                                • Slide 209
                                                                                                                                                                                                                                                                                                • Slide 210
                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                • Slide 212
                                                                                                                                                                                                                                                                                                • Slide 213
                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                • Slide 215
                                                                                                                                                                                                                                                                                                • Slide 216
                                                                                                                                                                                                                                                                                                • Slide 217
                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                • A challengehellip
                                                                                                                                                                                                                                                                                                • Slide 222

                                                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                                  Vh jeff w puritan oilVc kate re brimfieldTC umass dermatology Spoke w cindy 508 8564000

                                                                                                                                                                                                                                                                                                  Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                                  Learn French

                                                                                                                                                                                                                                                                                                  Stop smoking

                                                                                                                                                                                                                                                                                                  Be a better spouse

                                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                  The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                  Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                                                                                                                                                  DavidNowell

                                                                                                                                                                                                                                                                                                  • Slide 1
                                                                                                                                                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                                                                                                                                                  • Slide 3
                                                                                                                                                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                  • Slide 7
                                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                  • Overview
                                                                                                                                                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                  • Slide 17
                                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                  • Slide 19
                                                                                                                                                                                                                                                                                                  • Strategies
                                                                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                                                                                                                  • Slide 23
                                                                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                  • Slide 25
                                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                  • Slide 27
                                                                                                                                                                                                                                                                                                  • Slide 28
                                                                                                                                                                                                                                                                                                  • Slide 29
                                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                  • Slide 35
                                                                                                                                                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                                                                                                                                                  • (C)APD
                                                                                                                                                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                  • Self-assessment
                                                                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                  • Slide 42
                                                                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                  • Core symptoms
                                                                                                                                                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                  • Slide 53
                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                  • Slide 63
                                                                                                                                                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                                                                                                                                                  • Slide 66
                                                                                                                                                                                                                                                                                                  • Slide 67
                                                                                                                                                                                                                                                                                                  • ADHD and women
                                                                                                                                                                                                                                                                                                  • Slide 69
                                                                                                                                                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                  • Slide 74
                                                                                                                                                                                                                                                                                                  • Slide 75
                                                                                                                                                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                  • Slide 84
                                                                                                                                                                                                                                                                                                  • Slide 85
                                                                                                                                                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                                                                                                                                                  • Slide 89
                                                                                                                                                                                                                                                                                                  • Slide 90
                                                                                                                                                                                                                                                                                                  • Slide 91
                                                                                                                                                                                                                                                                                                  • Slide 92
                                                                                                                                                                                                                                                                                                  • Slide 93
                                                                                                                                                                                                                                                                                                  • Slide 94
                                                                                                                                                                                                                                                                                                  • Slide 95
                                                                                                                                                                                                                                                                                                  • Slide 96
                                                                                                                                                                                                                                                                                                  • Slide 97
                                                                                                                                                                                                                                                                                                  • Slide 98
                                                                                                                                                                                                                                                                                                  • Slide 99
                                                                                                                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                                                                                                                  • Slide 101
                                                                                                                                                                                                                                                                                                  • Slide 102
                                                                                                                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                                                                                                                  • Slide 106
                                                                                                                                                                                                                                                                                                  • Slide 107
                                                                                                                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                                                                                                                  • Slide 109
                                                                                                                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                                                                                                                  • Time Out
                                                                                                                                                                                                                                                                                                  • Token economy
                                                                                                                                                                                                                                                                                                  • Slide 113
                                                                                                                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                                                                                                                  • Slide 115
                                                                                                                                                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                                                                                                                                                  • Slide 117
                                                                                                                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                                                                                                                  • Metacognition
                                                                                                                                                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                  • Slide 124
                                                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                  • Slide 128
                                                                                                                                                                                                                                                                                                  • Slide 129
                                                                                                                                                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                  • Slide 141
                                                                                                                                                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                  • Slide 146
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                  • Slide 149
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                  • Slide 152
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                  • Slide 154
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                  • Slide 157
                                                                                                                                                                                                                                                                                                  • Slide 158
                                                                                                                                                                                                                                                                                                  • Slide 159
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                  • Slide 162
                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                  • Slide 164
                                                                                                                                                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                  • Slide 166
                                                                                                                                                                                                                                                                                                  • Slide 167
                                                                                                                                                                                                                                                                                                  • Slide 168
                                                                                                                                                                                                                                                                                                  • Slide 169
                                                                                                                                                                                                                                                                                                  • Slide 170
                                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                  • Match the Picture
                                                                                                                                                                                                                                                                                                  • Slide 176
                                                                                                                                                                                                                                                                                                  • Slide 177
                                                                                                                                                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                                                                                                                                                  • Slide 179
                                                                                                                                                                                                                                                                                                  • Slide 180
                                                                                                                                                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                                                                                                                                                  • Learning Time
                                                                                                                                                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                                                                                                                                                  • Slide 185
                                                                                                                                                                                                                                                                                                  • Slide 186
                                                                                                                                                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                                                                                                                                                  • Slide 189
                                                                                                                                                                                                                                                                                                  • Slide 190
                                                                                                                                                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                  • Slide 194
                                                                                                                                                                                                                                                                                                  • Slide 195
                                                                                                                                                                                                                                                                                                  • Slide 196
                                                                                                                                                                                                                                                                                                  • Slide 197
                                                                                                                                                                                                                                                                                                  • Slide 198
                                                                                                                                                                                                                                                                                                  • Slide 199
                                                                                                                                                                                                                                                                                                  • Slide 200
                                                                                                                                                                                                                                                                                                  • Slide 201
                                                                                                                                                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                                                                                                                                                  • The post-mortem
                                                                                                                                                                                                                                                                                                  • Slide 204
                                                                                                                                                                                                                                                                                                  • Slide 205
                                                                                                                                                                                                                                                                                                  • Slide 206
                                                                                                                                                                                                                                                                                                  • Slide 207
                                                                                                                                                                                                                                                                                                  • Slide 208
                                                                                                                                                                                                                                                                                                  • Slide 209
                                                                                                                                                                                                                                                                                                  • Slide 210
                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                  • Slide 212
                                                                                                                                                                                                                                                                                                  • Slide 213
                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                  • Slide 215
                                                                                                                                                                                                                                                                                                  • Slide 216
                                                                                                                                                                                                                                                                                                  • Slide 217
                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                  • A challengehellip
                                                                                                                                                                                                                                                                                                  • Slide 222

                                                                                                                                                                                                                                                                                                    Your 1 Organizational Tool

                                                                                                                                                                                                                                                                                                    Learn French

                                                                                                                                                                                                                                                                                                    Stop smoking

                                                                                                                                                                                                                                                                                                    Be a better spouse

                                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                    The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                    Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                    A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                                                                                                                                                    DavidNowell

                                                                                                                                                                                                                                                                                                    • Slide 1
                                                                                                                                                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                                                                                                                                                    • Slide 3
                                                                                                                                                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                    • Slide 7
                                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                    • Overview
                                                                                                                                                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                    • Slide 17
                                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                    • Slide 19
                                                                                                                                                                                                                                                                                                    • Strategies
                                                                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                                                                                                                    • Slide 23
                                                                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                    • Slide 25
                                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                    • Slide 27
                                                                                                                                                                                                                                                                                                    • Slide 28
                                                                                                                                                                                                                                                                                                    • Slide 29
                                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                    • Slide 35
                                                                                                                                                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                                                                                                                                                    • (C)APD
                                                                                                                                                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                    • Self-assessment
                                                                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                    • Slide 42
                                                                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                    • Core symptoms
                                                                                                                                                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                    • Slide 53
                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                    • Slide 63
                                                                                                                                                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                                                                                                                                                    • Slide 66
                                                                                                                                                                                                                                                                                                    • Slide 67
                                                                                                                                                                                                                                                                                                    • ADHD and women
                                                                                                                                                                                                                                                                                                    • Slide 69
                                                                                                                                                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                    • Slide 74
                                                                                                                                                                                                                                                                                                    • Slide 75
                                                                                                                                                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                    • Slide 84
                                                                                                                                                                                                                                                                                                    • Slide 85
                                                                                                                                                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                                                                                                                                                    • Slide 89
                                                                                                                                                                                                                                                                                                    • Slide 90
                                                                                                                                                                                                                                                                                                    • Slide 91
                                                                                                                                                                                                                                                                                                    • Slide 92
                                                                                                                                                                                                                                                                                                    • Slide 93
                                                                                                                                                                                                                                                                                                    • Slide 94
                                                                                                                                                                                                                                                                                                    • Slide 95
                                                                                                                                                                                                                                                                                                    • Slide 96
                                                                                                                                                                                                                                                                                                    • Slide 97
                                                                                                                                                                                                                                                                                                    • Slide 98
                                                                                                                                                                                                                                                                                                    • Slide 99
                                                                                                                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                                                                                                                    • Slide 101
                                                                                                                                                                                                                                                                                                    • Slide 102
                                                                                                                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                                                                                                                    • Slide 106
                                                                                                                                                                                                                                                                                                    • Slide 107
                                                                                                                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                                                                                                                    • Slide 109
                                                                                                                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                                                                                                                    • Time Out
                                                                                                                                                                                                                                                                                                    • Token economy
                                                                                                                                                                                                                                                                                                    • Slide 113
                                                                                                                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                                                                                                                    • Slide 115
                                                                                                                                                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                                                                                                                                                    • Slide 117
                                                                                                                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                                                                                                                    • Metacognition
                                                                                                                                                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                    • Slide 124
                                                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                    • Slide 128
                                                                                                                                                                                                                                                                                                    • Slide 129
                                                                                                                                                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                    • Slide 141
                                                                                                                                                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                    • Slide 146
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                    • Slide 149
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                    • Slide 152
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                    • Slide 154
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                    • Slide 157
                                                                                                                                                                                                                                                                                                    • Slide 158
                                                                                                                                                                                                                                                                                                    • Slide 159
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                    • Slide 162
                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                    • Slide 164
                                                                                                                                                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                    • Slide 166
                                                                                                                                                                                                                                                                                                    • Slide 167
                                                                                                                                                                                                                                                                                                    • Slide 168
                                                                                                                                                                                                                                                                                                    • Slide 169
                                                                                                                                                                                                                                                                                                    • Slide 170
                                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                    • Match the Picture
                                                                                                                                                                                                                                                                                                    • Slide 176
                                                                                                                                                                                                                                                                                                    • Slide 177
                                                                                                                                                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                                                                                                                                                    • Slide 179
                                                                                                                                                                                                                                                                                                    • Slide 180
                                                                                                                                                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                                                                                                                                                    • Learning Time
                                                                                                                                                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                                                                                                                                                    • Slide 185
                                                                                                                                                                                                                                                                                                    • Slide 186
                                                                                                                                                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                                                                                                                                                    • Slide 189
                                                                                                                                                                                                                                                                                                    • Slide 190
                                                                                                                                                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                    • Slide 194
                                                                                                                                                                                                                                                                                                    • Slide 195
                                                                                                                                                                                                                                                                                                    • Slide 196
                                                                                                                                                                                                                                                                                                    • Slide 197
                                                                                                                                                                                                                                                                                                    • Slide 198
                                                                                                                                                                                                                                                                                                    • Slide 199
                                                                                                                                                                                                                                                                                                    • Slide 200
                                                                                                                                                                                                                                                                                                    • Slide 201
                                                                                                                                                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                                                                                                                                                    • The post-mortem
                                                                                                                                                                                                                                                                                                    • Slide 204
                                                                                                                                                                                                                                                                                                    • Slide 205
                                                                                                                                                                                                                                                                                                    • Slide 206
                                                                                                                                                                                                                                                                                                    • Slide 207
                                                                                                                                                                                                                                                                                                    • Slide 208
                                                                                                                                                                                                                                                                                                    • Slide 209
                                                                                                                                                                                                                                                                                                    • Slide 210
                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                    • Slide 212
                                                                                                                                                                                                                                                                                                    • Slide 213
                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                    • Slide 215
                                                                                                                                                                                                                                                                                                    • Slide 216
                                                                                                                                                                                                                                                                                                    • Slide 217
                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                    • A challengehellip
                                                                                                                                                                                                                                                                                                    • Slide 222

                                                                                                                                                                                                                                                                                                      Learn French

                                                                                                                                                                                                                                                                                                      Stop smoking

                                                                                                                                                                                                                                                                                                      Be a better spouse

                                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                      The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                      Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                      A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                      wwwDrNowellcom

                                                                                                                                                                                                                                                                                                      Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                      DavidNowellSeminars

                                                                                                                                                                                                                                                                                                      DavidNowell

                                                                                                                                                                                                                                                                                                      • Slide 1
                                                                                                                                                                                                                                                                                                      • hellipa challenge
                                                                                                                                                                                                                                                                                                      • Slide 3
                                                                                                                                                                                                                                                                                                      • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                      • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                      • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                      • Slide 7
                                                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                      • Overview
                                                                                                                                                                                                                                                                                                      • This Dense Pudding
                                                                                                                                                                                                                                                                                                      • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                                                                                                                                      • Developmental considerations
                                                                                                                                                                                                                                                                                                      • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                      • Slide 17
                                                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                      • Slide 19
                                                                                                                                                                                                                                                                                                      • Strategies
                                                                                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                                                                                                                                      • Slide 23
                                                                                                                                                                                                                                                                                                      • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                      • Slide 25
                                                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                      • Slide 27
                                                                                                                                                                                                                                                                                                      • Slide 28
                                                                                                                                                                                                                                                                                                      • Slide 29
                                                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                      • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                      • CAPD or ADHD
                                                                                                                                                                                                                                                                                                      • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                      • Slide 35
                                                                                                                                                                                                                                                                                                      • Strategies (2)
                                                                                                                                                                                                                                                                                                      • (C)APD
                                                                                                                                                                                                                                                                                                      • Treatment for CAPD
                                                                                                                                                                                                                                                                                                      • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                      • Self-assessment
                                                                                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                      • Slide 42
                                                                                                                                                                                                                                                                                                      • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                      • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                      • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                      • Core symptoms
                                                                                                                                                                                                                                                                                                      • Core symptoms (2)
                                                                                                                                                                                                                                                                                                      • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                      • Slide 53
                                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                      • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                      • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                      • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                      • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                      • Slide 63
                                                                                                                                                                                                                                                                                                      • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                      • ADHD and girls
                                                                                                                                                                                                                                                                                                      • Slide 66
                                                                                                                                                                                                                                                                                                      • Slide 67
                                                                                                                                                                                                                                                                                                      • ADHD and women
                                                                                                                                                                                                                                                                                                      • Slide 69
                                                                                                                                                                                                                                                                                                      • ADHD and women (2)
                                                                                                                                                                                                                                                                                                      • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                      • The Executive Functions
                                                                                                                                                                                                                                                                                                      • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                      • Slide 74
                                                                                                                                                                                                                                                                                                      • Slide 75
                                                                                                                                                                                                                                                                                                      • Appropriate expectations
                                                                                                                                                                                                                                                                                                      • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                      • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                      • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                      • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                      • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                      • Slide 84
                                                                                                                                                                                                                                                                                                      • Slide 85
                                                                                                                                                                                                                                                                                                      • Strategies (3)
                                                                                                                                                                                                                                                                                                      • Pharmacotherapy
                                                                                                                                                                                                                                                                                                      • Behavioral Supports
                                                                                                                                                                                                                                                                                                      • Slide 89
                                                                                                                                                                                                                                                                                                      • Slide 90
                                                                                                                                                                                                                                                                                                      • Slide 91
                                                                                                                                                                                                                                                                                                      • Slide 92
                                                                                                                                                                                                                                                                                                      • Slide 93
                                                                                                                                                                                                                                                                                                      • Slide 94
                                                                                                                                                                                                                                                                                                      • Slide 95
                                                                                                                                                                                                                                                                                                      • Slide 96
                                                                                                                                                                                                                                                                                                      • Slide 97
                                                                                                                                                                                                                                                                                                      • Slide 98
                                                                                                                                                                                                                                                                                                      • Slide 99
                                                                                                                                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                                                                                                                                      • Slide 101
                                                                                                                                                                                                                                                                                                      • Slide 102
                                                                                                                                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                                                                                                                                      • Slide 106
                                                                                                                                                                                                                                                                                                      • Slide 107
                                                                                                                                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                                                                                                                                      • Slide 109
                                                                                                                                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                                                                                                                                      • Time Out
                                                                                                                                                                                                                                                                                                      • Token economy
                                                                                                                                                                                                                                                                                                      • Slide 113
                                                                                                                                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                                                                                                                                      • Slide 115
                                                                                                                                                                                                                                                                                                      • Intrinsic motivation
                                                                                                                                                                                                                                                                                                      • Slide 117
                                                                                                                                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                                                                                                                                      • Metacognition
                                                                                                                                                                                                                                                                                                      • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                      • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                      • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                      • Slide 124
                                                                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                      • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                      • Slide 128
                                                                                                                                                                                                                                                                                                      • Slide 129
                                                                                                                                                                                                                                                                                                      • Broaden and Build
                                                                                                                                                                                                                                                                                                      • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                      • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                      • The reward-and-planning system
                                                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                      • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                      • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                      • Slide 141
                                                                                                                                                                                                                                                                                                      • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                      • Slide 146
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                      • Slide 149
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                      • Slide 152
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                      • Slide 154
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                      • Slide 157
                                                                                                                                                                                                                                                                                                      • Slide 158
                                                                                                                                                                                                                                                                                                      • Slide 159
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                      • Slide 162
                                                                                                                                                                                                                                                                                                      • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                      • Slide 164
                                                                                                                                                                                                                                                                                                      • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                      • Slide 166
                                                                                                                                                                                                                                                                                                      • Slide 167
                                                                                                                                                                                                                                                                                                      • Slide 168
                                                                                                                                                                                                                                                                                                      • Slide 169
                                                                                                                                                                                                                                                                                                      • Slide 170
                                                                                                                                                                                                                                                                                                      • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                      • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                      • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                      • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                      • Match the Picture
                                                                                                                                                                                                                                                                                                      • Slide 176
                                                                                                                                                                                                                                                                                                      • Slide 177
                                                                                                                                                                                                                                                                                                      • Distraction Delay Training
                                                                                                                                                                                                                                                                                                      • Slide 179
                                                                                                                                                                                                                                                                                                      • Slide 180
                                                                                                                                                                                                                                                                                                      • Executive Estimates Training
                                                                                                                                                                                                                                                                                                      • Learning Time
                                                                                                                                                                                                                                                                                                      • Learning Time (2)
                                                                                                                                                                                                                                                                                                      • Learning Time (3)
                                                                                                                                                                                                                                                                                                      • Slide 185
                                                                                                                                                                                                                                                                                                      • Slide 186
                                                                                                                                                                                                                                                                                                      • Learning Time (4)
                                                                                                                                                                                                                                                                                                      • Asking two questionshellip
                                                                                                                                                                                                                                                                                                      • Slide 189
                                                                                                                                                                                                                                                                                                      • Slide 190
                                                                                                                                                                                                                                                                                                      • Key Features of Video Games
                                                                                                                                                                                                                                                                                                      • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                      • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                      • Slide 194
                                                                                                                                                                                                                                                                                                      • Slide 195
                                                                                                                                                                                                                                                                                                      • Slide 196
                                                                                                                                                                                                                                                                                                      • Slide 197
                                                                                                                                                                                                                                                                                                      • Slide 198
                                                                                                                                                                                                                                                                                                      • Slide 199
                                                                                                                                                                                                                                                                                                      • Slide 200
                                                                                                                                                                                                                                                                                                      • Slide 201
                                                                                                                                                                                                                                                                                                      • Quarterly QI review
                                                                                                                                                                                                                                                                                                      • The post-mortem
                                                                                                                                                                                                                                                                                                      • Slide 204
                                                                                                                                                                                                                                                                                                      • Slide 205
                                                                                                                                                                                                                                                                                                      • Slide 206
                                                                                                                                                                                                                                                                                                      • Slide 207
                                                                                                                                                                                                                                                                                                      • Slide 208
                                                                                                                                                                                                                                                                                                      • Slide 209
                                                                                                                                                                                                                                                                                                      • Slide 210
                                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                      • Slide 212
                                                                                                                                                                                                                                                                                                      • Slide 213
                                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                      • Slide 215
                                                                                                                                                                                                                                                                                                      • Slide 216
                                                                                                                                                                                                                                                                                                      • Slide 217
                                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                      • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                      • A challengehellip
                                                                                                                                                                                                                                                                                                      • Slide 222

                                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                        The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                        Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                        A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                        wwwDrNowellcom

                                                                                                                                                                                                                                                                                                        Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                        DavidNowellSeminars

                                                                                                                                                                                                                                                                                                        DavidNowell

                                                                                                                                                                                                                                                                                                        • Slide 1
                                                                                                                                                                                                                                                                                                        • hellipa challenge
                                                                                                                                                                                                                                                                                                        • Slide 3
                                                                                                                                                                                                                                                                                                        • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                        • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                        • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                        • Slide 7
                                                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                        • Overview
                                                                                                                                                                                                                                                                                                        • This Dense Pudding
                                                                                                                                                                                                                                                                                                        • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                                                                                                                                        • Developmental considerations
                                                                                                                                                                                                                                                                                                        • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                        • Slide 17
                                                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                        • Slide 19
                                                                                                                                                                                                                                                                                                        • Strategies
                                                                                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                                                                                                                                        • Slide 23
                                                                                                                                                                                                                                                                                                        • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                        • Slide 25
                                                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                        • Slide 27
                                                                                                                                                                                                                                                                                                        • Slide 28
                                                                                                                                                                                                                                                                                                        • Slide 29
                                                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                        • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                        • CAPD or ADHD
                                                                                                                                                                                                                                                                                                        • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                        • Slide 35
                                                                                                                                                                                                                                                                                                        • Strategies (2)
                                                                                                                                                                                                                                                                                                        • (C)APD
                                                                                                                                                                                                                                                                                                        • Treatment for CAPD
                                                                                                                                                                                                                                                                                                        • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                        • Self-assessment
                                                                                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                        • Slide 42
                                                                                                                                                                                                                                                                                                        • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                        • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                        • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                        • Core symptoms
                                                                                                                                                                                                                                                                                                        • Core symptoms (2)
                                                                                                                                                                                                                                                                                                        • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                        • Slide 53
                                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                        • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                        • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                        • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                        • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                        • Slide 63
                                                                                                                                                                                                                                                                                                        • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                        • ADHD and girls
                                                                                                                                                                                                                                                                                                        • Slide 66
                                                                                                                                                                                                                                                                                                        • Slide 67
                                                                                                                                                                                                                                                                                                        • ADHD and women
                                                                                                                                                                                                                                                                                                        • Slide 69
                                                                                                                                                                                                                                                                                                        • ADHD and women (2)
                                                                                                                                                                                                                                                                                                        • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                        • The Executive Functions
                                                                                                                                                                                                                                                                                                        • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                        • Slide 74
                                                                                                                                                                                                                                                                                                        • Slide 75
                                                                                                                                                                                                                                                                                                        • Appropriate expectations
                                                                                                                                                                                                                                                                                                        • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                        • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                        • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                        • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                        • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                        • Slide 84
                                                                                                                                                                                                                                                                                                        • Slide 85
                                                                                                                                                                                                                                                                                                        • Strategies (3)
                                                                                                                                                                                                                                                                                                        • Pharmacotherapy
                                                                                                                                                                                                                                                                                                        • Behavioral Supports
                                                                                                                                                                                                                                                                                                        • Slide 89
                                                                                                                                                                                                                                                                                                        • Slide 90
                                                                                                                                                                                                                                                                                                        • Slide 91
                                                                                                                                                                                                                                                                                                        • Slide 92
                                                                                                                                                                                                                                                                                                        • Slide 93
                                                                                                                                                                                                                                                                                                        • Slide 94
                                                                                                                                                                                                                                                                                                        • Slide 95
                                                                                                                                                                                                                                                                                                        • Slide 96
                                                                                                                                                                                                                                                                                                        • Slide 97
                                                                                                                                                                                                                                                                                                        • Slide 98
                                                                                                                                                                                                                                                                                                        • Slide 99
                                                                                                                                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                                                                                                                                        • Slide 101
                                                                                                                                                                                                                                                                                                        • Slide 102
                                                                                                                                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                                                                                                                                        • Slide 106
                                                                                                                                                                                                                                                                                                        • Slide 107
                                                                                                                                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                                                                                                                                        • Slide 109
                                                                                                                                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                                                                                                                                        • Time Out
                                                                                                                                                                                                                                                                                                        • Token economy
                                                                                                                                                                                                                                                                                                        • Slide 113
                                                                                                                                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                                                                                                                                        • Slide 115
                                                                                                                                                                                                                                                                                                        • Intrinsic motivation
                                                                                                                                                                                                                                                                                                        • Slide 117
                                                                                                                                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                                                                                                                                        • Metacognition
                                                                                                                                                                                                                                                                                                        • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                        • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                        • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                        • Slide 124
                                                                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                        • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                        • Slide 128
                                                                                                                                                                                                                                                                                                        • Slide 129
                                                                                                                                                                                                                                                                                                        • Broaden and Build
                                                                                                                                                                                                                                                                                                        • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                        • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                        • The reward-and-planning system
                                                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                        • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                        • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                        • Slide 141
                                                                                                                                                                                                                                                                                                        • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                        • Slide 146
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                        • Slide 149
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                        • Slide 152
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                        • Slide 154
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                        • Slide 157
                                                                                                                                                                                                                                                                                                        • Slide 158
                                                                                                                                                                                                                                                                                                        • Slide 159
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                        • Slide 162
                                                                                                                                                                                                                                                                                                        • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                        • Slide 164
                                                                                                                                                                                                                                                                                                        • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                        • Slide 166
                                                                                                                                                                                                                                                                                                        • Slide 167
                                                                                                                                                                                                                                                                                                        • Slide 168
                                                                                                                                                                                                                                                                                                        • Slide 169
                                                                                                                                                                                                                                                                                                        • Slide 170
                                                                                                                                                                                                                                                                                                        • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                        • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                        • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                        • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                        • Match the Picture
                                                                                                                                                                                                                                                                                                        • Slide 176
                                                                                                                                                                                                                                                                                                        • Slide 177
                                                                                                                                                                                                                                                                                                        • Distraction Delay Training
                                                                                                                                                                                                                                                                                                        • Slide 179
                                                                                                                                                                                                                                                                                                        • Slide 180
                                                                                                                                                                                                                                                                                                        • Executive Estimates Training
                                                                                                                                                                                                                                                                                                        • Learning Time
                                                                                                                                                                                                                                                                                                        • Learning Time (2)
                                                                                                                                                                                                                                                                                                        • Learning Time (3)
                                                                                                                                                                                                                                                                                                        • Slide 185
                                                                                                                                                                                                                                                                                                        • Slide 186
                                                                                                                                                                                                                                                                                                        • Learning Time (4)
                                                                                                                                                                                                                                                                                                        • Asking two questionshellip
                                                                                                                                                                                                                                                                                                        • Slide 189
                                                                                                                                                                                                                                                                                                        • Slide 190
                                                                                                                                                                                                                                                                                                        • Key Features of Video Games
                                                                                                                                                                                                                                                                                                        • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                        • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                        • Slide 194
                                                                                                                                                                                                                                                                                                        • Slide 195
                                                                                                                                                                                                                                                                                                        • Slide 196
                                                                                                                                                                                                                                                                                                        • Slide 197
                                                                                                                                                                                                                                                                                                        • Slide 198
                                                                                                                                                                                                                                                                                                        • Slide 199
                                                                                                                                                                                                                                                                                                        • Slide 200
                                                                                                                                                                                                                                                                                                        • Slide 201
                                                                                                                                                                                                                                                                                                        • Quarterly QI review
                                                                                                                                                                                                                                                                                                        • The post-mortem
                                                                                                                                                                                                                                                                                                        • Slide 204
                                                                                                                                                                                                                                                                                                        • Slide 205
                                                                                                                                                                                                                                                                                                        • Slide 206
                                                                                                                                                                                                                                                                                                        • Slide 207
                                                                                                                                                                                                                                                                                                        • Slide 208
                                                                                                                                                                                                                                                                                                        • Slide 209
                                                                                                                                                                                                                                                                                                        • Slide 210
                                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                        • Slide 212
                                                                                                                                                                                                                                                                                                        • Slide 213
                                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                        • Slide 215
                                                                                                                                                                                                                                                                                                        • Slide 216
                                                                                                                                                                                                                                                                                                        • Slide 217
                                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                        • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                        • A challengehellip
                                                                                                                                                                                                                                                                                                        • Slide 222

                                                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                          The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                          Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                          A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                          wwwDrNowellcom

                                                                                                                                                                                                                                                                                                          Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                          DavidNowellSeminars

                                                                                                                                                                                                                                                                                                          DavidNowell

                                                                                                                                                                                                                                                                                                          • Slide 1
                                                                                                                                                                                                                                                                                                          • hellipa challenge
                                                                                                                                                                                                                                                                                                          • Slide 3
                                                                                                                                                                                                                                                                                                          • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                          • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                          • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                          • Slide 7
                                                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                          • Overview
                                                                                                                                                                                                                                                                                                          • This Dense Pudding
                                                                                                                                                                                                                                                                                                          • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                                                                                                                                          • Developmental considerations
                                                                                                                                                                                                                                                                                                          • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                          • Slide 17
                                                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                          • Slide 19
                                                                                                                                                                                                                                                                                                          • Strategies
                                                                                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                                                                                                                                          • Slide 23
                                                                                                                                                                                                                                                                                                          • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                          • Slide 25
                                                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                          • Slide 27
                                                                                                                                                                                                                                                                                                          • Slide 28
                                                                                                                                                                                                                                                                                                          • Slide 29
                                                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                          • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                          • CAPD or ADHD
                                                                                                                                                                                                                                                                                                          • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                          • Slide 35
                                                                                                                                                                                                                                                                                                          • Strategies (2)
                                                                                                                                                                                                                                                                                                          • (C)APD
                                                                                                                                                                                                                                                                                                          • Treatment for CAPD
                                                                                                                                                                                                                                                                                                          • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                          • Self-assessment
                                                                                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                          • Slide 42
                                                                                                                                                                                                                                                                                                          • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                          • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                          • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                          • Core symptoms
                                                                                                                                                                                                                                                                                                          • Core symptoms (2)
                                                                                                                                                                                                                                                                                                          • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                          • Slide 53
                                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                          • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                          • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                          • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                          • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                          • Slide 63
                                                                                                                                                                                                                                                                                                          • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                          • ADHD and girls
                                                                                                                                                                                                                                                                                                          • Slide 66
                                                                                                                                                                                                                                                                                                          • Slide 67
                                                                                                                                                                                                                                                                                                          • ADHD and women
                                                                                                                                                                                                                                                                                                          • Slide 69
                                                                                                                                                                                                                                                                                                          • ADHD and women (2)
                                                                                                                                                                                                                                                                                                          • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                          • The Executive Functions
                                                                                                                                                                                                                                                                                                          • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                          • Slide 74
                                                                                                                                                                                                                                                                                                          • Slide 75
                                                                                                                                                                                                                                                                                                          • Appropriate expectations
                                                                                                                                                                                                                                                                                                          • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                          • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                          • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                          • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                          • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                          • Slide 84
                                                                                                                                                                                                                                                                                                          • Slide 85
                                                                                                                                                                                                                                                                                                          • Strategies (3)
                                                                                                                                                                                                                                                                                                          • Pharmacotherapy
                                                                                                                                                                                                                                                                                                          • Behavioral Supports
                                                                                                                                                                                                                                                                                                          • Slide 89
                                                                                                                                                                                                                                                                                                          • Slide 90
                                                                                                                                                                                                                                                                                                          • Slide 91
                                                                                                                                                                                                                                                                                                          • Slide 92
                                                                                                                                                                                                                                                                                                          • Slide 93
                                                                                                                                                                                                                                                                                                          • Slide 94
                                                                                                                                                                                                                                                                                                          • Slide 95
                                                                                                                                                                                                                                                                                                          • Slide 96
                                                                                                                                                                                                                                                                                                          • Slide 97
                                                                                                                                                                                                                                                                                                          • Slide 98
                                                                                                                                                                                                                                                                                                          • Slide 99
                                                                                                                                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                                                                                                                                          • Slide 101
                                                                                                                                                                                                                                                                                                          • Slide 102
                                                                                                                                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                                                                                                                                          • Slide 106
                                                                                                                                                                                                                                                                                                          • Slide 107
                                                                                                                                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                                                                                                                                          • Slide 109
                                                                                                                                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                                                                                                                                          • Time Out
                                                                                                                                                                                                                                                                                                          • Token economy
                                                                                                                                                                                                                                                                                                          • Slide 113
                                                                                                                                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                                                                                                                                          • Slide 115
                                                                                                                                                                                                                                                                                                          • Intrinsic motivation
                                                                                                                                                                                                                                                                                                          • Slide 117
                                                                                                                                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                                                                                                                                          • Metacognition
                                                                                                                                                                                                                                                                                                          • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                          • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                          • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                          • Slide 124
                                                                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                          • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                          • Slide 128
                                                                                                                                                                                                                                                                                                          • Slide 129
                                                                                                                                                                                                                                                                                                          • Broaden and Build
                                                                                                                                                                                                                                                                                                          • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                          • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                          • The reward-and-planning system
                                                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                          • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                          • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                          • Slide 141
                                                                                                                                                                                                                                                                                                          • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                          • Slide 146
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                          • Slide 149
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                          • Slide 152
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                          • Slide 154
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                          • Slide 157
                                                                                                                                                                                                                                                                                                          • Slide 158
                                                                                                                                                                                                                                                                                                          • Slide 159
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                          • Slide 162
                                                                                                                                                                                                                                                                                                          • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                          • Slide 164
                                                                                                                                                                                                                                                                                                          • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                          • Slide 166
                                                                                                                                                                                                                                                                                                          • Slide 167
                                                                                                                                                                                                                                                                                                          • Slide 168
                                                                                                                                                                                                                                                                                                          • Slide 169
                                                                                                                                                                                                                                                                                                          • Slide 170
                                                                                                                                                                                                                                                                                                          • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                          • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                          • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                          • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                          • Match the Picture
                                                                                                                                                                                                                                                                                                          • Slide 176
                                                                                                                                                                                                                                                                                                          • Slide 177
                                                                                                                                                                                                                                                                                                          • Distraction Delay Training
                                                                                                                                                                                                                                                                                                          • Slide 179
                                                                                                                                                                                                                                                                                                          • Slide 180
                                                                                                                                                                                                                                                                                                          • Executive Estimates Training
                                                                                                                                                                                                                                                                                                          • Learning Time
                                                                                                                                                                                                                                                                                                          • Learning Time (2)
                                                                                                                                                                                                                                                                                                          • Learning Time (3)
                                                                                                                                                                                                                                                                                                          • Slide 185
                                                                                                                                                                                                                                                                                                          • Slide 186
                                                                                                                                                                                                                                                                                                          • Learning Time (4)
                                                                                                                                                                                                                                                                                                          • Asking two questionshellip
                                                                                                                                                                                                                                                                                                          • Slide 189
                                                                                                                                                                                                                                                                                                          • Slide 190
                                                                                                                                                                                                                                                                                                          • Key Features of Video Games
                                                                                                                                                                                                                                                                                                          • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                          • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                          • Slide 194
                                                                                                                                                                                                                                                                                                          • Slide 195
                                                                                                                                                                                                                                                                                                          • Slide 196
                                                                                                                                                                                                                                                                                                          • Slide 197
                                                                                                                                                                                                                                                                                                          • Slide 198
                                                                                                                                                                                                                                                                                                          • Slide 199
                                                                                                                                                                                                                                                                                                          • Slide 200
                                                                                                                                                                                                                                                                                                          • Slide 201
                                                                                                                                                                                                                                                                                                          • Quarterly QI review
                                                                                                                                                                                                                                                                                                          • The post-mortem
                                                                                                                                                                                                                                                                                                          • Slide 204
                                                                                                                                                                                                                                                                                                          • Slide 205
                                                                                                                                                                                                                                                                                                          • Slide 206
                                                                                                                                                                                                                                                                                                          • Slide 207
                                                                                                                                                                                                                                                                                                          • Slide 208
                                                                                                                                                                                                                                                                                                          • Slide 209
                                                                                                                                                                                                                                                                                                          • Slide 210
                                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                          • Slide 212
                                                                                                                                                                                                                                                                                                          • Slide 213
                                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                          • Slide 215
                                                                                                                                                                                                                                                                                                          • Slide 216
                                                                                                                                                                                                                                                                                                          • Slide 217
                                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                          • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                          • A challengehellip
                                                                                                                                                                                                                                                                                                          • Slide 222

                                                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                            The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                            Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                            A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                            wwwDrNowellcom

                                                                                                                                                                                                                                                                                                            Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                            DavidNowellSeminars

                                                                                                                                                                                                                                                                                                            DavidNowell

                                                                                                                                                                                                                                                                                                            • Slide 1
                                                                                                                                                                                                                                                                                                            • hellipa challenge
                                                                                                                                                                                                                                                                                                            • Slide 3
                                                                                                                                                                                                                                                                                                            • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                            • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                            • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                            • Slide 7
                                                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                            • Overview
                                                                                                                                                                                                                                                                                                            • This Dense Pudding
                                                                                                                                                                                                                                                                                                            • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                                                                                                                                            • Developmental considerations
                                                                                                                                                                                                                                                                                                            • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                            • Slide 17
                                                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                            • Slide 19
                                                                                                                                                                                                                                                                                                            • Strategies
                                                                                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                                                                                                                                            • Slide 23
                                                                                                                                                                                                                                                                                                            • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                            • Slide 25
                                                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                            • Slide 27
                                                                                                                                                                                                                                                                                                            • Slide 28
                                                                                                                                                                                                                                                                                                            • Slide 29
                                                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                            • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                            • CAPD or ADHD
                                                                                                                                                                                                                                                                                                            • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                            • Slide 35
                                                                                                                                                                                                                                                                                                            • Strategies (2)
                                                                                                                                                                                                                                                                                                            • (C)APD
                                                                                                                                                                                                                                                                                                            • Treatment for CAPD
                                                                                                                                                                                                                                                                                                            • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                            • Self-assessment
                                                                                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                            • Slide 42
                                                                                                                                                                                                                                                                                                            • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                            • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                            • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                            • Core symptoms
                                                                                                                                                                                                                                                                                                            • Core symptoms (2)
                                                                                                                                                                                                                                                                                                            • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                            • Slide 53
                                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                            • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                            • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                            • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                            • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                            • Slide 63
                                                                                                                                                                                                                                                                                                            • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                            • ADHD and girls
                                                                                                                                                                                                                                                                                                            • Slide 66
                                                                                                                                                                                                                                                                                                            • Slide 67
                                                                                                                                                                                                                                                                                                            • ADHD and women
                                                                                                                                                                                                                                                                                                            • Slide 69
                                                                                                                                                                                                                                                                                                            • ADHD and women (2)
                                                                                                                                                                                                                                                                                                            • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                            • The Executive Functions
                                                                                                                                                                                                                                                                                                            • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                            • Slide 74
                                                                                                                                                                                                                                                                                                            • Slide 75
                                                                                                                                                                                                                                                                                                            • Appropriate expectations
                                                                                                                                                                                                                                                                                                            • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                            • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                            • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                            • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                            • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                            • Slide 84
                                                                                                                                                                                                                                                                                                            • Slide 85
                                                                                                                                                                                                                                                                                                            • Strategies (3)
                                                                                                                                                                                                                                                                                                            • Pharmacotherapy
                                                                                                                                                                                                                                                                                                            • Behavioral Supports
                                                                                                                                                                                                                                                                                                            • Slide 89
                                                                                                                                                                                                                                                                                                            • Slide 90
                                                                                                                                                                                                                                                                                                            • Slide 91
                                                                                                                                                                                                                                                                                                            • Slide 92
                                                                                                                                                                                                                                                                                                            • Slide 93
                                                                                                                                                                                                                                                                                                            • Slide 94
                                                                                                                                                                                                                                                                                                            • Slide 95
                                                                                                                                                                                                                                                                                                            • Slide 96
                                                                                                                                                                                                                                                                                                            • Slide 97
                                                                                                                                                                                                                                                                                                            • Slide 98
                                                                                                                                                                                                                                                                                                            • Slide 99
                                                                                                                                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                                                                                                                                            • Slide 101
                                                                                                                                                                                                                                                                                                            • Slide 102
                                                                                                                                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                                                                                                                                            • Slide 106
                                                                                                                                                                                                                                                                                                            • Slide 107
                                                                                                                                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                                                                                                                                            • Slide 109
                                                                                                                                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                                                                                                                                            • Time Out
                                                                                                                                                                                                                                                                                                            • Token economy
                                                                                                                                                                                                                                                                                                            • Slide 113
                                                                                                                                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                                                                                                                                            • Slide 115
                                                                                                                                                                                                                                                                                                            • Intrinsic motivation
                                                                                                                                                                                                                                                                                                            • Slide 117
                                                                                                                                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                                                                                                                                            • Metacognition
                                                                                                                                                                                                                                                                                                            • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                            • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                            • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                            • Slide 124
                                                                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                            • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                            • Slide 128
                                                                                                                                                                                                                                                                                                            • Slide 129
                                                                                                                                                                                                                                                                                                            • Broaden and Build
                                                                                                                                                                                                                                                                                                            • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                            • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                            • The reward-and-planning system
                                                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                            • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                            • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                            • Slide 141
                                                                                                                                                                                                                                                                                                            • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                            • Slide 146
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                            • Slide 149
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                            • Slide 152
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                            • Slide 154
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                            • Slide 157
                                                                                                                                                                                                                                                                                                            • Slide 158
                                                                                                                                                                                                                                                                                                            • Slide 159
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                            • Slide 162
                                                                                                                                                                                                                                                                                                            • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                            • Slide 164
                                                                                                                                                                                                                                                                                                            • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                            • Slide 166
                                                                                                                                                                                                                                                                                                            • Slide 167
                                                                                                                                                                                                                                                                                                            • Slide 168
                                                                                                                                                                                                                                                                                                            • Slide 169
                                                                                                                                                                                                                                                                                                            • Slide 170
                                                                                                                                                                                                                                                                                                            • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                            • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                            • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                            • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                            • Match the Picture
                                                                                                                                                                                                                                                                                                            • Slide 176
                                                                                                                                                                                                                                                                                                            • Slide 177
                                                                                                                                                                                                                                                                                                            • Distraction Delay Training
                                                                                                                                                                                                                                                                                                            • Slide 179
                                                                                                                                                                                                                                                                                                            • Slide 180
                                                                                                                                                                                                                                                                                                            • Executive Estimates Training
                                                                                                                                                                                                                                                                                                            • Learning Time
                                                                                                                                                                                                                                                                                                            • Learning Time (2)
                                                                                                                                                                                                                                                                                                            • Learning Time (3)
                                                                                                                                                                                                                                                                                                            • Slide 185
                                                                                                                                                                                                                                                                                                            • Slide 186
                                                                                                                                                                                                                                                                                                            • Learning Time (4)
                                                                                                                                                                                                                                                                                                            • Asking two questionshellip
                                                                                                                                                                                                                                                                                                            • Slide 189
                                                                                                                                                                                                                                                                                                            • Slide 190
                                                                                                                                                                                                                                                                                                            • Key Features of Video Games
                                                                                                                                                                                                                                                                                                            • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                            • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                            • Slide 194
                                                                                                                                                                                                                                                                                                            • Slide 195
                                                                                                                                                                                                                                                                                                            • Slide 196
                                                                                                                                                                                                                                                                                                            • Slide 197
                                                                                                                                                                                                                                                                                                            • Slide 198
                                                                                                                                                                                                                                                                                                            • Slide 199
                                                                                                                                                                                                                                                                                                            • Slide 200
                                                                                                                                                                                                                                                                                                            • Slide 201
                                                                                                                                                                                                                                                                                                            • Quarterly QI review
                                                                                                                                                                                                                                                                                                            • The post-mortem
                                                                                                                                                                                                                                                                                                            • Slide 204
                                                                                                                                                                                                                                                                                                            • Slide 205
                                                                                                                                                                                                                                                                                                            • Slide 206
                                                                                                                                                                                                                                                                                                            • Slide 207
                                                                                                                                                                                                                                                                                                            • Slide 208
                                                                                                                                                                                                                                                                                                            • Slide 209
                                                                                                                                                                                                                                                                                                            • Slide 210
                                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                            • Slide 212
                                                                                                                                                                                                                                                                                                            • Slide 213
                                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                            • Slide 215
                                                                                                                                                                                                                                                                                                            • Slide 216
                                                                                                                                                                                                                                                                                                            • Slide 217
                                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                            • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                            • A challengehellip
                                                                                                                                                                                                                                                                                                            • Slide 222

                                                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                              The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                              Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                              A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                              wwwDrNowellcom

                                                                                                                                                                                                                                                                                                              Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                              DavidNowellSeminars

                                                                                                                                                                                                                                                                                                              DavidNowell

                                                                                                                                                                                                                                                                                                              • Slide 1
                                                                                                                                                                                                                                                                                                              • hellipa challenge
                                                                                                                                                                                                                                                                                                              • Slide 3
                                                                                                                                                                                                                                                                                                              • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                              • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                              • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                              • Slide 7
                                                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                              • Overview
                                                                                                                                                                                                                                                                                                              • This Dense Pudding
                                                                                                                                                                                                                                                                                                              • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                                                                                                                                              • Developmental considerations
                                                                                                                                                                                                                                                                                                              • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                              • Slide 17
                                                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                              • Slide 19
                                                                                                                                                                                                                                                                                                              • Strategies
                                                                                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                                                                                                                                              • Slide 23
                                                                                                                                                                                                                                                                                                              • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                              • Slide 25
                                                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                              • Slide 27
                                                                                                                                                                                                                                                                                                              • Slide 28
                                                                                                                                                                                                                                                                                                              • Slide 29
                                                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                              • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                              • CAPD or ADHD
                                                                                                                                                                                                                                                                                                              • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                              • Slide 35
                                                                                                                                                                                                                                                                                                              • Strategies (2)
                                                                                                                                                                                                                                                                                                              • (C)APD
                                                                                                                                                                                                                                                                                                              • Treatment for CAPD
                                                                                                                                                                                                                                                                                                              • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                              • Self-assessment
                                                                                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                              • Slide 42
                                                                                                                                                                                                                                                                                                              • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                              • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                              • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                              • Core symptoms
                                                                                                                                                                                                                                                                                                              • Core symptoms (2)
                                                                                                                                                                                                                                                                                                              • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                              • Slide 53
                                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                              • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                              • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                              • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                              • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                              • Slide 63
                                                                                                                                                                                                                                                                                                              • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                              • ADHD and girls
                                                                                                                                                                                                                                                                                                              • Slide 66
                                                                                                                                                                                                                                                                                                              • Slide 67
                                                                                                                                                                                                                                                                                                              • ADHD and women
                                                                                                                                                                                                                                                                                                              • Slide 69
                                                                                                                                                                                                                                                                                                              • ADHD and women (2)
                                                                                                                                                                                                                                                                                                              • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                              • The Executive Functions
                                                                                                                                                                                                                                                                                                              • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                              • Slide 74
                                                                                                                                                                                                                                                                                                              • Slide 75
                                                                                                                                                                                                                                                                                                              • Appropriate expectations
                                                                                                                                                                                                                                                                                                              • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                              • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                              • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                              • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                              • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                              • Slide 84
                                                                                                                                                                                                                                                                                                              • Slide 85
                                                                                                                                                                                                                                                                                                              • Strategies (3)
                                                                                                                                                                                                                                                                                                              • Pharmacotherapy
                                                                                                                                                                                                                                                                                                              • Behavioral Supports
                                                                                                                                                                                                                                                                                                              • Slide 89
                                                                                                                                                                                                                                                                                                              • Slide 90
                                                                                                                                                                                                                                                                                                              • Slide 91
                                                                                                                                                                                                                                                                                                              • Slide 92
                                                                                                                                                                                                                                                                                                              • Slide 93
                                                                                                                                                                                                                                                                                                              • Slide 94
                                                                                                                                                                                                                                                                                                              • Slide 95
                                                                                                                                                                                                                                                                                                              • Slide 96
                                                                                                                                                                                                                                                                                                              • Slide 97
                                                                                                                                                                                                                                                                                                              • Slide 98
                                                                                                                                                                                                                                                                                                              • Slide 99
                                                                                                                                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                                                                                                                                              • Slide 101
                                                                                                                                                                                                                                                                                                              • Slide 102
                                                                                                                                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                                                                                                                                              • Slide 106
                                                                                                                                                                                                                                                                                                              • Slide 107
                                                                                                                                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                                                                                                                                              • Slide 109
                                                                                                                                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                                                                                                                                              • Time Out
                                                                                                                                                                                                                                                                                                              • Token economy
                                                                                                                                                                                                                                                                                                              • Slide 113
                                                                                                                                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                                                                                                                                              • Slide 115
                                                                                                                                                                                                                                                                                                              • Intrinsic motivation
                                                                                                                                                                                                                                                                                                              • Slide 117
                                                                                                                                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                                                                                                                                              • Metacognition
                                                                                                                                                                                                                                                                                                              • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                              • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                              • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                              • Slide 124
                                                                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                              • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                              • Slide 128
                                                                                                                                                                                                                                                                                                              • Slide 129
                                                                                                                                                                                                                                                                                                              • Broaden and Build
                                                                                                                                                                                                                                                                                                              • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                              • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                              • The reward-and-planning system
                                                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                              • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                              • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                              • Slide 141
                                                                                                                                                                                                                                                                                                              • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                              • Slide 146
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                              • Slide 149
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                              • Slide 152
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                              • Slide 154
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                              • Slide 157
                                                                                                                                                                                                                                                                                                              • Slide 158
                                                                                                                                                                                                                                                                                                              • Slide 159
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                              • Slide 162
                                                                                                                                                                                                                                                                                                              • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                              • Slide 164
                                                                                                                                                                                                                                                                                                              • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                              • Slide 166
                                                                                                                                                                                                                                                                                                              • Slide 167
                                                                                                                                                                                                                                                                                                              • Slide 168
                                                                                                                                                                                                                                                                                                              • Slide 169
                                                                                                                                                                                                                                                                                                              • Slide 170
                                                                                                                                                                                                                                                                                                              • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                              • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                              • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                              • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                              • Match the Picture
                                                                                                                                                                                                                                                                                                              • Slide 176
                                                                                                                                                                                                                                                                                                              • Slide 177
                                                                                                                                                                                                                                                                                                              • Distraction Delay Training
                                                                                                                                                                                                                                                                                                              • Slide 179
                                                                                                                                                                                                                                                                                                              • Slide 180
                                                                                                                                                                                                                                                                                                              • Executive Estimates Training
                                                                                                                                                                                                                                                                                                              • Learning Time
                                                                                                                                                                                                                                                                                                              • Learning Time (2)
                                                                                                                                                                                                                                                                                                              • Learning Time (3)
                                                                                                                                                                                                                                                                                                              • Slide 185
                                                                                                                                                                                                                                                                                                              • Slide 186
                                                                                                                                                                                                                                                                                                              • Learning Time (4)
                                                                                                                                                                                                                                                                                                              • Asking two questionshellip
                                                                                                                                                                                                                                                                                                              • Slide 189
                                                                                                                                                                                                                                                                                                              • Slide 190
                                                                                                                                                                                                                                                                                                              • Key Features of Video Games
                                                                                                                                                                                                                                                                                                              • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                              • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                              • Slide 194
                                                                                                                                                                                                                                                                                                              • Slide 195
                                                                                                                                                                                                                                                                                                              • Slide 196
                                                                                                                                                                                                                                                                                                              • Slide 197
                                                                                                                                                                                                                                                                                                              • Slide 198
                                                                                                                                                                                                                                                                                                              • Slide 199
                                                                                                                                                                                                                                                                                                              • Slide 200
                                                                                                                                                                                                                                                                                                              • Slide 201
                                                                                                                                                                                                                                                                                                              • Quarterly QI review
                                                                                                                                                                                                                                                                                                              • The post-mortem
                                                                                                                                                                                                                                                                                                              • Slide 204
                                                                                                                                                                                                                                                                                                              • Slide 205
                                                                                                                                                                                                                                                                                                              • Slide 206
                                                                                                                                                                                                                                                                                                              • Slide 207
                                                                                                                                                                                                                                                                                                              • Slide 208
                                                                                                                                                                                                                                                                                                              • Slide 209
                                                                                                                                                                                                                                                                                                              • Slide 210
                                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                              • Slide 212
                                                                                                                                                                                                                                                                                                              • Slide 213
                                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                              • Slide 215
                                                                                                                                                                                                                                                                                                              • Slide 216
                                                                                                                                                                                                                                                                                                              • Slide 217
                                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                              • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                              • A challengehellip
                                                                                                                                                                                                                                                                                                              • Slide 222

                                                                                                                                                                                                                                                                                                                The ldquoBig Fiverdquo

                                                                                                                                                                                                                                                                                                                Daily focus time Valuesmotivational clarity Nutrition Movement Connection

                                                                                                                                                                                                                                                                                                                A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                                wwwDrNowellcom

                                                                                                                                                                                                                                                                                                                Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                                DavidNowellSeminars

                                                                                                                                                                                                                                                                                                                DavidNowell

                                                                                                                                                                                                                                                                                                                • Slide 1
                                                                                                                                                                                                                                                                                                                • hellipa challenge
                                                                                                                                                                                                                                                                                                                • Slide 3
                                                                                                                                                                                                                                                                                                                • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                                • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                                • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                                • Slide 7
                                                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                                • Overview
                                                                                                                                                                                                                                                                                                                • This Dense Pudding
                                                                                                                                                                                                                                                                                                                • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                                                                                                                                • Developmental considerations
                                                                                                                                                                                                                                                                                                                • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                                • Slide 17
                                                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                                • Slide 19
                                                                                                                                                                                                                                                                                                                • Strategies
                                                                                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                                                                                                                                • Slide 23
                                                                                                                                                                                                                                                                                                                • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                                • Slide 25
                                                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                                • Slide 27
                                                                                                                                                                                                                                                                                                                • Slide 28
                                                                                                                                                                                                                                                                                                                • Slide 29
                                                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                                • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                                • CAPD or ADHD
                                                                                                                                                                                                                                                                                                                • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                                • Slide 35
                                                                                                                                                                                                                                                                                                                • Strategies (2)
                                                                                                                                                                                                                                                                                                                • (C)APD
                                                                                                                                                                                                                                                                                                                • Treatment for CAPD
                                                                                                                                                                                                                                                                                                                • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                                • Self-assessment
                                                                                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                                • Slide 42
                                                                                                                                                                                                                                                                                                                • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                                • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                                • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                                • Core symptoms
                                                                                                                                                                                                                                                                                                                • Core symptoms (2)
                                                                                                                                                                                                                                                                                                                • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                                • Slide 53
                                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                                • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                                • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                                • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                                • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                                • Slide 63
                                                                                                                                                                                                                                                                                                                • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                                • ADHD and girls
                                                                                                                                                                                                                                                                                                                • Slide 66
                                                                                                                                                                                                                                                                                                                • Slide 67
                                                                                                                                                                                                                                                                                                                • ADHD and women
                                                                                                                                                                                                                                                                                                                • Slide 69
                                                                                                                                                                                                                                                                                                                • ADHD and women (2)
                                                                                                                                                                                                                                                                                                                • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                                • The Executive Functions
                                                                                                                                                                                                                                                                                                                • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                                • Slide 74
                                                                                                                                                                                                                                                                                                                • Slide 75
                                                                                                                                                                                                                                                                                                                • Appropriate expectations
                                                                                                                                                                                                                                                                                                                • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                                • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                                • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                                • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                                • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                                • Slide 84
                                                                                                                                                                                                                                                                                                                • Slide 85
                                                                                                                                                                                                                                                                                                                • Strategies (3)
                                                                                                                                                                                                                                                                                                                • Pharmacotherapy
                                                                                                                                                                                                                                                                                                                • Behavioral Supports
                                                                                                                                                                                                                                                                                                                • Slide 89
                                                                                                                                                                                                                                                                                                                • Slide 90
                                                                                                                                                                                                                                                                                                                • Slide 91
                                                                                                                                                                                                                                                                                                                • Slide 92
                                                                                                                                                                                                                                                                                                                • Slide 93
                                                                                                                                                                                                                                                                                                                • Slide 94
                                                                                                                                                                                                                                                                                                                • Slide 95
                                                                                                                                                                                                                                                                                                                • Slide 96
                                                                                                                                                                                                                                                                                                                • Slide 97
                                                                                                                                                                                                                                                                                                                • Slide 98
                                                                                                                                                                                                                                                                                                                • Slide 99
                                                                                                                                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                                                                                                                                • Slide 101
                                                                                                                                                                                                                                                                                                                • Slide 102
                                                                                                                                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                                                                                                                                • Slide 106
                                                                                                                                                                                                                                                                                                                • Slide 107
                                                                                                                                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                                                                                                                                • Slide 109
                                                                                                                                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                                                                                                                                • Time Out
                                                                                                                                                                                                                                                                                                                • Token economy
                                                                                                                                                                                                                                                                                                                • Slide 113
                                                                                                                                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                                                                                                                                • Slide 115
                                                                                                                                                                                                                                                                                                                • Intrinsic motivation
                                                                                                                                                                                                                                                                                                                • Slide 117
                                                                                                                                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                                                                                                                                • Metacognition
                                                                                                                                                                                                                                                                                                                • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                                • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                                • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                                • Slide 124
                                                                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                                • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                                • Slide 128
                                                                                                                                                                                                                                                                                                                • Slide 129
                                                                                                                                                                                                                                                                                                                • Broaden and Build
                                                                                                                                                                                                                                                                                                                • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                                • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                                • The reward-and-planning system
                                                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                                • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                                • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                                • Slide 141
                                                                                                                                                                                                                                                                                                                • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                                • Slide 146
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                                • Slide 149
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                                • Slide 152
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                                • Slide 154
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                                • Slide 157
                                                                                                                                                                                                                                                                                                                • Slide 158
                                                                                                                                                                                                                                                                                                                • Slide 159
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                                • Slide 162
                                                                                                                                                                                                                                                                                                                • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                                • Slide 164
                                                                                                                                                                                                                                                                                                                • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                                • Slide 166
                                                                                                                                                                                                                                                                                                                • Slide 167
                                                                                                                                                                                                                                                                                                                • Slide 168
                                                                                                                                                                                                                                                                                                                • Slide 169
                                                                                                                                                                                                                                                                                                                • Slide 170
                                                                                                                                                                                                                                                                                                                • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                                • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                                • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                                • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                                • Match the Picture
                                                                                                                                                                                                                                                                                                                • Slide 176
                                                                                                                                                                                                                                                                                                                • Slide 177
                                                                                                                                                                                                                                                                                                                • Distraction Delay Training
                                                                                                                                                                                                                                                                                                                • Slide 179
                                                                                                                                                                                                                                                                                                                • Slide 180
                                                                                                                                                                                                                                                                                                                • Executive Estimates Training
                                                                                                                                                                                                                                                                                                                • Learning Time
                                                                                                                                                                                                                                                                                                                • Learning Time (2)
                                                                                                                                                                                                                                                                                                                • Learning Time (3)
                                                                                                                                                                                                                                                                                                                • Slide 185
                                                                                                                                                                                                                                                                                                                • Slide 186
                                                                                                                                                                                                                                                                                                                • Learning Time (4)
                                                                                                                                                                                                                                                                                                                • Asking two questionshellip
                                                                                                                                                                                                                                                                                                                • Slide 189
                                                                                                                                                                                                                                                                                                                • Slide 190
                                                                                                                                                                                                                                                                                                                • Key Features of Video Games
                                                                                                                                                                                                                                                                                                                • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                                • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                                • Slide 194
                                                                                                                                                                                                                                                                                                                • Slide 195
                                                                                                                                                                                                                                                                                                                • Slide 196
                                                                                                                                                                                                                                                                                                                • Slide 197
                                                                                                                                                                                                                                                                                                                • Slide 198
                                                                                                                                                                                                                                                                                                                • Slide 199
                                                                                                                                                                                                                                                                                                                • Slide 200
                                                                                                                                                                                                                                                                                                                • Slide 201
                                                                                                                                                                                                                                                                                                                • Quarterly QI review
                                                                                                                                                                                                                                                                                                                • The post-mortem
                                                                                                                                                                                                                                                                                                                • Slide 204
                                                                                                                                                                                                                                                                                                                • Slide 205
                                                                                                                                                                                                                                                                                                                • Slide 206
                                                                                                                                                                                                                                                                                                                • Slide 207
                                                                                                                                                                                                                                                                                                                • Slide 208
                                                                                                                                                                                                                                                                                                                • Slide 209
                                                                                                                                                                                                                                                                                                                • Slide 210
                                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                                • Slide 212
                                                                                                                                                                                                                                                                                                                • Slide 213
                                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                                • Slide 215
                                                                                                                                                                                                                                                                                                                • Slide 216
                                                                                                                                                                                                                                                                                                                • Slide 217
                                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                                • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                                • A challengehellip
                                                                                                                                                                                                                                                                                                                • Slide 222

                                                                                                                                                                                                                                                                                                                  A CHALLENGEhellip

                                                                                                                                                                                                                                                                                                                  wwwDrNowellcom

                                                                                                                                                                                                                                                                                                                  Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                                  DavidNowellSeminars

                                                                                                                                                                                                                                                                                                                  DavidNowell

                                                                                                                                                                                                                                                                                                                  • Slide 1
                                                                                                                                                                                                                                                                                                                  • hellipa challenge
                                                                                                                                                                                                                                                                                                                  • Slide 3
                                                                                                                                                                                                                                                                                                                  • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                                  • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                                  • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                                  • Slide 7
                                                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                                  • Overview
                                                                                                                                                                                                                                                                                                                  • This Dense Pudding
                                                                                                                                                                                                                                                                                                                  • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                                                                                                                                  • Developmental considerations
                                                                                                                                                                                                                                                                                                                  • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                                  • Slide 17
                                                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                                  • Slide 19
                                                                                                                                                                                                                                                                                                                  • Strategies
                                                                                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                                                                                                                                  • Slide 23
                                                                                                                                                                                                                                                                                                                  • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                                  • Slide 25
                                                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                                  • Slide 27
                                                                                                                                                                                                                                                                                                                  • Slide 28
                                                                                                                                                                                                                                                                                                                  • Slide 29
                                                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                                  • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                                  • CAPD or ADHD
                                                                                                                                                                                                                                                                                                                  • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                                  • Slide 35
                                                                                                                                                                                                                                                                                                                  • Strategies (2)
                                                                                                                                                                                                                                                                                                                  • (C)APD
                                                                                                                                                                                                                                                                                                                  • Treatment for CAPD
                                                                                                                                                                                                                                                                                                                  • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                                  • Self-assessment
                                                                                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                                  • Slide 42
                                                                                                                                                                                                                                                                                                                  • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                                  • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                                  • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                                  • Core symptoms
                                                                                                                                                                                                                                                                                                                  • Core symptoms (2)
                                                                                                                                                                                                                                                                                                                  • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                                  • Slide 53
                                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                                  • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                                  • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                                  • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                                  • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                                  • Slide 63
                                                                                                                                                                                                                                                                                                                  • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                                  • ADHD and girls
                                                                                                                                                                                                                                                                                                                  • Slide 66
                                                                                                                                                                                                                                                                                                                  • Slide 67
                                                                                                                                                                                                                                                                                                                  • ADHD and women
                                                                                                                                                                                                                                                                                                                  • Slide 69
                                                                                                                                                                                                                                                                                                                  • ADHD and women (2)
                                                                                                                                                                                                                                                                                                                  • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                                  • The Executive Functions
                                                                                                                                                                                                                                                                                                                  • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                                  • Slide 74
                                                                                                                                                                                                                                                                                                                  • Slide 75
                                                                                                                                                                                                                                                                                                                  • Appropriate expectations
                                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                                  • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                                  • Slide 84
                                                                                                                                                                                                                                                                                                                  • Slide 85
                                                                                                                                                                                                                                                                                                                  • Strategies (3)
                                                                                                                                                                                                                                                                                                                  • Pharmacotherapy
                                                                                                                                                                                                                                                                                                                  • Behavioral Supports
                                                                                                                                                                                                                                                                                                                  • Slide 89
                                                                                                                                                                                                                                                                                                                  • Slide 90
                                                                                                                                                                                                                                                                                                                  • Slide 91
                                                                                                                                                                                                                                                                                                                  • Slide 92
                                                                                                                                                                                                                                                                                                                  • Slide 93
                                                                                                                                                                                                                                                                                                                  • Slide 94
                                                                                                                                                                                                                                                                                                                  • Slide 95
                                                                                                                                                                                                                                                                                                                  • Slide 96
                                                                                                                                                                                                                                                                                                                  • Slide 97
                                                                                                                                                                                                                                                                                                                  • Slide 98
                                                                                                                                                                                                                                                                                                                  • Slide 99
                                                                                                                                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                                                                                                                                  • Slide 101
                                                                                                                                                                                                                                                                                                                  • Slide 102
                                                                                                                                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                                                                                                                                  • Slide 106
                                                                                                                                                                                                                                                                                                                  • Slide 107
                                                                                                                                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                                                                                                                                  • Slide 109
                                                                                                                                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                                                                                                                                  • Time Out
                                                                                                                                                                                                                                                                                                                  • Token economy
                                                                                                                                                                                                                                                                                                                  • Slide 113
                                                                                                                                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                                                                                                                                  • Slide 115
                                                                                                                                                                                                                                                                                                                  • Intrinsic motivation
                                                                                                                                                                                                                                                                                                                  • Slide 117
                                                                                                                                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                                                                                                                                  • Metacognition
                                                                                                                                                                                                                                                                                                                  • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                                  • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                                  • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                                  • Slide 124
                                                                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                                  • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                                  • Slide 128
                                                                                                                                                                                                                                                                                                                  • Slide 129
                                                                                                                                                                                                                                                                                                                  • Broaden and Build
                                                                                                                                                                                                                                                                                                                  • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                                  • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                                  • The reward-and-planning system
                                                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                                  • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                                  • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                                  • Slide 141
                                                                                                                                                                                                                                                                                                                  • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                                  • Slide 146
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                                  • Slide 149
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                                  • Slide 152
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                                  • Slide 154
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                                  • Slide 157
                                                                                                                                                                                                                                                                                                                  • Slide 158
                                                                                                                                                                                                                                                                                                                  • Slide 159
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                                  • Slide 162
                                                                                                                                                                                                                                                                                                                  • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                                  • Slide 164
                                                                                                                                                                                                                                                                                                                  • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                                  • Slide 166
                                                                                                                                                                                                                                                                                                                  • Slide 167
                                                                                                                                                                                                                                                                                                                  • Slide 168
                                                                                                                                                                                                                                                                                                                  • Slide 169
                                                                                                                                                                                                                                                                                                                  • Slide 170
                                                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                                  • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                                  • Match the Picture
                                                                                                                                                                                                                                                                                                                  • Slide 176
                                                                                                                                                                                                                                                                                                                  • Slide 177
                                                                                                                                                                                                                                                                                                                  • Distraction Delay Training
                                                                                                                                                                                                                                                                                                                  • Slide 179
                                                                                                                                                                                                                                                                                                                  • Slide 180
                                                                                                                                                                                                                                                                                                                  • Executive Estimates Training
                                                                                                                                                                                                                                                                                                                  • Learning Time
                                                                                                                                                                                                                                                                                                                  • Learning Time (2)
                                                                                                                                                                                                                                                                                                                  • Learning Time (3)
                                                                                                                                                                                                                                                                                                                  • Slide 185
                                                                                                                                                                                                                                                                                                                  • Slide 186
                                                                                                                                                                                                                                                                                                                  • Learning Time (4)
                                                                                                                                                                                                                                                                                                                  • Asking two questionshellip
                                                                                                                                                                                                                                                                                                                  • Slide 189
                                                                                                                                                                                                                                                                                                                  • Slide 190
                                                                                                                                                                                                                                                                                                                  • Key Features of Video Games
                                                                                                                                                                                                                                                                                                                  • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                                  • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                                  • Slide 194
                                                                                                                                                                                                                                                                                                                  • Slide 195
                                                                                                                                                                                                                                                                                                                  • Slide 196
                                                                                                                                                                                                                                                                                                                  • Slide 197
                                                                                                                                                                                                                                                                                                                  • Slide 198
                                                                                                                                                                                                                                                                                                                  • Slide 199
                                                                                                                                                                                                                                                                                                                  • Slide 200
                                                                                                                                                                                                                                                                                                                  • Slide 201
                                                                                                                                                                                                                                                                                                                  • Quarterly QI review
                                                                                                                                                                                                                                                                                                                  • The post-mortem
                                                                                                                                                                                                                                                                                                                  • Slide 204
                                                                                                                                                                                                                                                                                                                  • Slide 205
                                                                                                                                                                                                                                                                                                                  • Slide 206
                                                                                                                                                                                                                                                                                                                  • Slide 207
                                                                                                                                                                                                                                                                                                                  • Slide 208
                                                                                                                                                                                                                                                                                                                  • Slide 209
                                                                                                                                                                                                                                                                                                                  • Slide 210
                                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                                  • Slide 212
                                                                                                                                                                                                                                                                                                                  • Slide 213
                                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                                  • Slide 215
                                                                                                                                                                                                                                                                                                                  • Slide 216
                                                                                                                                                                                                                                                                                                                  • Slide 217
                                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                                  • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                                  • A challengehellip
                                                                                                                                                                                                                                                                                                                  • Slide 222

                                                                                                                                                                                                                                                                                                                    wwwDrNowellcom

                                                                                                                                                                                                                                                                                                                    Lend Me Your BrainPractical Strategies for Managing ADDADHDExecutive Dysfunction and Processing Disorders

                                                                                                                                                                                                                                                                                                                    DavidNowellSeminars

                                                                                                                                                                                                                                                                                                                    DavidNowell

                                                                                                                                                                                                                                                                                                                    • Slide 1
                                                                                                                                                                                                                                                                                                                    • hellipa challenge
                                                                                                                                                                                                                                                                                                                    • Slide 3
                                                                                                                                                                                                                                                                                                                    • Perspective of this workshophellip
                                                                                                                                                                                                                                                                                                                    • ldquoTop ndash downrdquo dysfunction
                                                                                                                                                                                                                                                                                                                    • ldquoBottom - uprdquo dysfunction
                                                                                                                                                                                                                                                                                                                    • Slide 7
                                                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal
                                                                                                                                                                                                                                                                                                                    • Overview
                                                                                                                                                                                                                                                                                                                    • This Dense Pudding
                                                                                                                                                                                                                                                                                                                    • Sensory Processing Disorder
                                                                                                                                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                                                                                                                                    • Developmental considerations
                                                                                                                                                                                                                                                                                                                    • Sensory ProcessingIntegration Disorder and DSM-V
                                                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (2)
                                                                                                                                                                                                                                                                                                                    • Slide 17
                                                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (3)
                                                                                                                                                                                                                                                                                                                    • Slide 19
                                                                                                                                                                                                                                                                                                                    • Strategies
                                                                                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders
                                                                                                                                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                                                                                                                                    • Slide 23
                                                                                                                                                                                                                                                                                                                    • Regulatory-Sensory Processing Disorders (2)
                                                                                                                                                                                                                                                                                                                    • Slide 25
                                                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder
                                                                                                                                                                                                                                                                                                                    • Slide 27
                                                                                                                                                                                                                                                                                                                    • Slide 28
                                                                                                                                                                                                                                                                                                                    • Slide 29
                                                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (2)
                                                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (3)
                                                                                                                                                                                                                                                                                                                    • Central Auditory Processing Disorder (4)
                                                                                                                                                                                                                                                                                                                    • CAPD or ADHD
                                                                                                                                                                                                                                                                                                                    • Whatrsquos the kidrsquos deal (4)
                                                                                                                                                                                                                                                                                                                    • Slide 35
                                                                                                                                                                                                                                                                                                                    • Strategies (2)
                                                                                                                                                                                                                                                                                                                    • (C)APD
                                                                                                                                                                                                                                                                                                                    • Treatment for CAPD
                                                                                                                                                                                                                                                                                                                    • Treatment for CAPD (2)
                                                                                                                                                                                                                                                                                                                    • Self-assessment
                                                                                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder
                                                                                                                                                                                                                                                                                                                    • Slide 42
                                                                                                                                                                                                                                                                                                                    • Attention Deficit Hyperactivity Disorder (2)
                                                                                                                                                                                                                                                                                                                    • (85 ndash X) x 365
                                                                                                                                                                                                                                                                                                                    • ldquoIrsquom gonna eat all the gum and candy I wantrdquo
                                                                                                                                                                                                                                                                                                                    • Core symptoms
                                                                                                                                                                                                                                                                                                                    • Core symptoms (2)
                                                                                                                                                                                                                                                                                                                    • hellipand the rest of the criteria
                                                                                                                                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms
                                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (2)
                                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (3)
                                                                                                                                                                                                                                                                                                                    • Slide 53
                                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (4)
                                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (5)
                                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (6)
                                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (7)
                                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (8)
                                                                                                                                                                                                                                                                                                                    • Functional impact of core symptoms (9)
                                                                                                                                                                                                                                                                                                                    • Subtypes of ADHD
                                                                                                                                                                                                                                                                                                                    • Subtypes of ADHD (2)
                                                                                                                                                                                                                                                                                                                    • Common comorbidities with ADHD
                                                                                                                                                                                                                                                                                                                    • Slide 63
                                                                                                                                                                                                                                                                                                                    • Common comorbidities with ADHD (2)
                                                                                                                                                                                                                                                                                                                    • ADHD and girls
                                                                                                                                                                                                                                                                                                                    • Slide 66
                                                                                                                                                                                                                                                                                                                    • Slide 67
                                                                                                                                                                                                                                                                                                                    • ADHD and women
                                                                                                                                                                                                                                                                                                                    • Slide 69
                                                                                                                                                                                                                                                                                                                    • ADHD and women (2)
                                                                                                                                                                                                                                                                                                                    • Executive Functioning An Overarching Theme
                                                                                                                                                                                                                                                                                                                    • The Executive Functions
                                                                                                                                                                                                                                                                                                                    • The Executive Functions (2)
                                                                                                                                                                                                                                                                                                                    • Slide 74
                                                                                                                                                                                                                                                                                                                    • Slide 75
                                                                                                                                                                                                                                                                                                                    • Appropriate expectations
                                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations
                                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (2)
                                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (3)
                                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (4)
                                                                                                                                                                                                                                                                                                                    • Age-appropriate expectations (5)
                                                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo
                                                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (2)
                                                                                                                                                                                                                                                                                                                    • Slide 84
                                                                                                                                                                                                                                                                                                                    • Slide 85
                                                                                                                                                                                                                                                                                                                    • Strategies (3)
                                                                                                                                                                                                                                                                                                                    • Pharmacotherapy
                                                                                                                                                                                                                                                                                                                    • Behavioral Supports
                                                                                                                                                                                                                                                                                                                    • Slide 89
                                                                                                                                                                                                                                                                                                                    • Slide 90
                                                                                                                                                                                                                                                                                                                    • Slide 91
                                                                                                                                                                                                                                                                                                                    • Slide 92
                                                                                                                                                                                                                                                                                                                    • Slide 93
                                                                                                                                                                                                                                                                                                                    • Slide 94
                                                                                                                                                                                                                                                                                                                    • Slide 95
                                                                                                                                                                                                                                                                                                                    • Slide 96
                                                                                                                                                                                                                                                                                                                    • Slide 97
                                                                                                                                                                                                                                                                                                                    • Slide 98
                                                                                                                                                                                                                                                                                                                    • Slide 99
                                                                                                                                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                                                                                                                                    • Slide 101
                                                                                                                                                                                                                                                                                                                    • Slide 102
                                                                                                                                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                                                                                                                                    • Slide 106
                                                                                                                                                                                                                                                                                                                    • Slide 107
                                                                                                                                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                                                                                                                                    • Slide 109
                                                                                                                                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                                                                                                                                    • Time Out
                                                                                                                                                                                                                                                                                                                    • Token economy
                                                                                                                                                                                                                                                                                                                    • Slide 113
                                                                                                                                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                                                                                                                                    • Slide 115
                                                                                                                                                                                                                                                                                                                    • Intrinsic motivation
                                                                                                                                                                                                                                                                                                                    • Slide 117
                                                                                                                                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                                                                                                                                    • Metacognition
                                                                                                                                                                                                                                                                                                                    • ldquoLend Me Your Brainrdquo
                                                                                                                                                                                                                                                                                                                    • What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                                    • Preferred States What Does Dopamine Feel Like
                                                                                                                                                                                                                                                                                                                    • Slide 124
                                                                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY
                                                                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (2)
                                                                                                                                                                                                                                                                                                                    • PREFERRED STATES INVENTORY (3)
                                                                                                                                                                                                                                                                                                                    • Slide 128
                                                                                                                                                                                                                                                                                                                    • Slide 129
                                                                                                                                                                                                                                                                                                                    • Broaden and Build
                                                                                                                                                                                                                                                                                                                    • ldquoNeuroMalleabilityrdquo
                                                                                                                                                                                                                                                                                                                    • Why You Arenrsquot Getting Exactly What You Want All the Time
                                                                                                                                                                                                                                                                                                                    • The reward-and-planning system
                                                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (3)
                                                                                                                                                                                                                                                                                                                    • ldquowhat isrdquo vs ldquowhat could berdquo (4)
                                                                                                                                                                                                                                                                                                                    • The reward-and-planning system (2)
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (2)
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (3)
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (4)
                                                                                                                                                                                                                                                                                                                    • Slide 141
                                                                                                                                                                                                                                                                                                                    • Lend Me Your Brain
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (5)
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (6)
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (7)
                                                                                                                                                                                                                                                                                                                    • Slide 146
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (8)
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (9)
                                                                                                                                                                                                                                                                                                                    • Slide 149
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (10)
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (11)
                                                                                                                                                                                                                                                                                                                    • Slide 152
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (12)
                                                                                                                                                                                                                                                                                                                    • Slide 154
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (13)
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (14)
                                                                                                                                                                                                                                                                                                                    • Slide 157
                                                                                                                                                                                                                                                                                                                    • Slide 158
                                                                                                                                                                                                                                                                                                                    • Slide 159
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (15)
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (16)
                                                                                                                                                                                                                                                                                                                    • Slide 162
                                                                                                                                                                                                                                                                                                                    • Ways the reward-and-planning system can go wrong (17)
                                                                                                                                                                                                                                                                                                                    • Slide 164
                                                                                                                                                                                                                                                                                                                    • Instant gratification vs executive gratification
                                                                                                                                                                                                                                                                                                                    • Slide 166
                                                                                                                                                                                                                                                                                                                    • Slide 167
                                                                                                                                                                                                                                                                                                                    • Slide 168
                                                                                                                                                                                                                                                                                                                    • Slide 169
                                                                                                                                                                                                                                                                                                                    • Slide 170
                                                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency
                                                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (2)
                                                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (3)
                                                                                                                                                                                                                                                                                                                    • Self-Talk Proficiency (4)
                                                                                                                                                                                                                                                                                                                    • Match the Picture
                                                                                                                                                                                                                                                                                                                    • Slide 176
                                                                                                                                                                                                                                                                                                                    • Slide 177
                                                                                                                                                                                                                                                                                                                    • Distraction Delay Training
                                                                                                                                                                                                                                                                                                                    • Slide 179
                                                                                                                                                                                                                                                                                                                    • Slide 180
                                                                                                                                                                                                                                                                                                                    • Executive Estimates Training
                                                                                                                                                                                                                                                                                                                    • Learning Time
                                                                                                                                                                                                                                                                                                                    • Learning Time (2)
                                                                                                                                                                                                                                                                                                                    • Learning Time (3)
                                                                                                                                                                                                                                                                                                                    • Slide 185
                                                                                                                                                                                                                                                                                                                    • Slide 186
                                                                                                                                                                                                                                                                                                                    • Learning Time (4)
                                                                                                                                                                                                                                                                                                                    • Asking two questionshellip
                                                                                                                                                                                                                                                                                                                    • Slide 189
                                                                                                                                                                                                                                                                                                                    • Slide 190
                                                                                                                                                                                                                                                                                                                    • Key Features of Video Games
                                                                                                                                                                                                                                                                                                                    • Key Features of Video Games (2)
                                                                                                                                                                                                                                                                                                                    • Methylphenidate Enhances the Saliency of a Mathematical Task by
                                                                                                                                                                                                                                                                                                                    • Slide 194
                                                                                                                                                                                                                                                                                                                    • Slide 195
                                                                                                                                                                                                                                                                                                                    • Slide 196
                                                                                                                                                                                                                                                                                                                    • Slide 197
                                                                                                                                                                                                                                                                                                                    • Slide 198
                                                                                                                                                                                                                                                                                                                    • Slide 199
                                                                                                                                                                                                                                                                                                                    • Slide 200
                                                                                                                                                                                                                                                                                                                    • Slide 201
                                                                                                                                                                                                                                                                                                                    • Quarterly QI review
                                                                                                                                                                                                                                                                                                                    • The post-mortem
                                                                                                                                                                                                                                                                                                                    • Slide 204
                                                                                                                                                                                                                                                                                                                    • Slide 205
                                                                                                                                                                                                                                                                                                                    • Slide 206
                                                                                                                                                                                                                                                                                                                    • Slide 207
                                                                                                                                                                                                                                                                                                                    • Slide 208
                                                                                                                                                                                                                                                                                                                    • Slide 209
                                                                                                                                                                                                                                                                                                                    • Slide 210
                                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo
                                                                                                                                                                                                                                                                                                                    • Slide 212
                                                                                                                                                                                                                                                                                                                    • Slide 213
                                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (2)
                                                                                                                                                                                                                                                                                                                    • Slide 215
                                                                                                                                                                                                                                                                                                                    • Slide 216
                                                                                                                                                                                                                                                                                                                    • Slide 217
                                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (3)
                                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (4)
                                                                                                                                                                                                                                                                                                                    • The ldquoBig Fiverdquo (5)
                                                                                                                                                                                                                                                                                                                    • A challengehellip
                                                                                                                                                                                                                                                                                                                    • Slide 222

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